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Research Topics
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Lung & Respiratory
Project Summary

Title: Evaluation of Respiratory Dysfunction Among Gulf War Veterans
Synopsis: The study aims to assess respiratory status in relation to exposure to oil well fires, in Gulf War veterans, to evaluate pulmonary dysfunction.
Overall Project Objective: To assess respiratory status in relation to exposure to oil fire pollution in Gulf War veterans and evaluate the relationship between measures of pulmonary dysfunction and respiratory symptoms and exposure in subjects recruited for Project #1.
Status/Results to Date: In May of 1999, study investigators were informed that funding would not be requested for the pulmonary study in the new application for continuation of funding for the Boston Environmental Hazard Research Center. Consequently recruitment and enrollment of new participants stopped. Ironically, we learned about the change in funding shortly after we secured an agreement with Maine Medical Center to conduct pulmonary function and methacholine evaluations for our identified control group. The controls consisted of members of an Air Ambulance Company from Maine that was activated and sent to Germany during the Gulf War. This was an important loss for the study, as it would have provided appropriate unexposed control data for the methacholine challenge test. The pulmonary study team is currently completing analysis of study data and preparing a manuscript for publication. A total of 101 pulmonary function tests were administered to 81unique participants. Twenty of the 67 participants tested during the first phase of the study returned to participate in the second phase of the study (methacholine challenge testing). Sixty- seven subjects completed conventional pulmonary function testing and respiratory and environmental questionnaires during the first phase of the study. An additional 33 subjects completed the methacholine challenge tests. Additionally and most importantly the team is integrating exposure location data provided by CHPPM (US Army Center for Health Promotion and Preventive Medicine) into our model along with the quantitative measures of respiratory function. We hope to utilize the new exposure data in our assessment of the relationship between oil well fire pollutant exposure and respiratory outcomes.
Project:VA-4D
Agency:Department Of Veterans' Affairs
Location:VAMC Boston
P.I. Name:Lewis Pepper, M.D.
Research Type:Clinical
Research Focus:Environmental Toxicology
Focus Category:Lung & Respiratory
Status:Complete
Study Start Date:October 01,1994
Estimated Completion Date:March 31,2000
Specific Aims: 1. Create a cumulative personal exposure estimate for each subject utilizing the U.S. Army Center for Health Promotion and Preventive Medicine (USACHPPM) exposure assessment data for their unit combined with geographic specific information which maps each unit's location in the Persian Gulf War theater; 2. Assess respiratory status using standardized respiratory questionnaire; 3. Assess respiratory function with physical examination and pulmonary function testing; 4. Assess pre-existing asthma risk with total serum IgE levels; 5. Assess non-specific bronchial responsiveness (BHR) as a measure of early outcome and as a potential risk factor in the development of lung disease by using methacholine challenge testing (initiating in Year 2 of the study); 6. Examine possible predictors of respiratory function (pulmonary function tests (PFT) and methacholine challenge test) using cumulative environmental exposure assessment variable, respiratory medical history, occupational history, and smoking status variables; 7. Develop a database from which to plan preventative interventions to reduce morbidity and mortality from respiratory diseases.
Methodology: Subjects will be veterans from the subjects evaluated in Project 1. Each will complete a standardized respiratory questionnaire, systematic cardio-pulmonary physical exam, and pulmonary function testing. Spirometric measures will include forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and FEV1/FVC in accordance with American Thoracic Society recommendations. Subject data will be adjusted for age, height and gender and transformed to percentage predicted values using Knudson predictive equations. Blood will be drawn by venapuncture at the time of the visit and total serum IgE, complete blood count and differential and quantitative immunoglobulin levels will be measured. Bronchial responsiveness will be determined via methacholine challenge testing. Nonspecific bronchial hyperresponsiveness has been suggested as a risk factor for, or an early event in the development of both acute and chronic occupational lung diseases. Occupational exposures to irritant substances at concentrations similar to the Gulf War exposures have been shown to cause airway hyperresponsiveness and it is believed that these exposures might be associated with the development of asthma.
Most Recent Publications:

Pepper L, Stinson MC, Proctor SP, Heaton K, Wolfe J, Ozonoff D, White RF. An evaluation of respiratory function and airborne environmental exposures among Persian Gulf veterans. N/A, In Progress. Manuscripts