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Multiple breath washout: A noninvasive tool for identifying lung disease in symptomatic military deployers
Respiratory Medicine ( IF 4.3 ) Pub Date : 2020-12-05 , DOI: 10.1016/j.rmed.2020.106281
Lauren M Zell-Baran 1 , Silpa D Krefft 2 , Camille M Moore 3 , Jenna Wolff 1 , Richard Meehan 4 , Cecile S Rose 4
Affiliation  

Rationale

Military deployments to austere environments since November 9, 2001 may put “deployers” at risk for respiratory disease. Sensitive, noninvasive tools for detecting large and small airways injury are needed to identify early disease and help inform management for this at-risk population.

Objectives

We examined multiple breath washout (MBW) as a tool for identifying deployment-related airways disease and assessed host and exposure risk factors compared to healthy controls.

Methods

Between March 2015 and March 2020, 103 healthy controls and 71 symptomatic deployers with asthma and/or distal lung disease completed a questionnaire, spirometry and MBW testing. SAS v. 9.4 was used to compare MBW parameters between deployers and controls via univariate analyses and adjusted for demographic factors using multiple linear regression.

Measurements and main results

Deployers were significantly more likely than controls to have an abnormal lung clearance index (LCI) score indicating global ventilation inhomogeneity. Adjusting for sex, smoking status, smoking pack-years and body mass index, LCI scores were significantly more abnormal among those with deployment-related asthma and distal lung disease compared to controls. The unadjusted variable Sacin (a marker of ventilation inhomogeneity in the acinar airways) was higher and thus more abnormal in those with both proximal and distal airways disease. Deployers who reported more frequent exposure to explosive blasts had significantly higher LCI scores.

Conclusions

This study demonstrates the utility of MBW in evaluating exposure-related airways disease in symptomatic military personnel following deployment to austere environments, and is the first to link exposure to explosive blasts to measurable small airways injury.



中文翻译:

多次呼气冲洗:一种用于识别有症状军事部署人员肺部疾病的无创工具

基本原理

自 2001 年 11 月 9 日以来在严峻环境中的军事部署可能会使“部署者”面临患呼吸道疾病的风险。需要用于检测大小气道损伤的灵敏、非侵入性工具来识别早期疾病并帮助告知对这一高危人群的管理。

目标

我们检查了多次呼气冲洗 (MBW) 作为识别与部署相关的气道疾病的工具,并与健康对照相比评估了宿主和暴露风险因素。

方法

2015 年 3 月至 2020 年 3 月期间,103 名健康对照者和 71 名患有哮喘和/或远端肺病的有症状的部​​署者完成了问卷、肺活量测定和 MBW 测试。SAS v. 9.4 用于通过单变量分析比较部署者和控制者之间的 MBW 参数,并使用多元线性回归调整人口统计因素。

测量和主要结果

与对照组相比,部署者更可能出现异常肺清除指数 (LCI) 评分,表明整体通气不均匀。调整性别、吸烟状况、吸烟包年数和体重指数后,与对照组相比,与部署相关的哮喘和远端肺病患者的 LCI 评分异常更显着。未经调整的变量 Sacin(腺泡气道通气不均匀性的标志)更高,因此在患有近端和远端气道疾病的患者中更加异常。报告更频繁地暴露于爆炸性爆炸的部署人员的 LCI 分数明显更高。

结论

这项研究证明了 MBW 在评估部署到严峻环境后有症状的军事人员的暴露相关气道疾病方面的效用,并且是第一个将暴露于爆炸性爆炸与可测量的小气道损伤联系起来的研究。

更新日期:2020-12-17
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