Small Airway Chronic Obstructive Disease Syndrome Following Exposure to WTC Dust

NYU Langone Health46 enrolled

Overview

Many "Survivors" in the World Trade Center (WTC) clinical program have a clinical syndrome characterized by chronic obstruction in small airways and persistence of lower respiratory symptoms despite therapy. This study will test the hypothesis that persistent symptoms in WTC "Survivors" are associated with abnormal small airways whose dysfunction is amplified during exercise and is associated with biologic evidence of inflammation and remodeling. The results from this study will have important treatment implications for our WTC population with potential applicability to larger populations with either inhalational lung injury and/or airway diseases such as asthma and chronic obstructive pulmonary disease.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

DIAGNOSTIC

Masking

NONE

Enrollment

Conditions

Chronic Obstructive Pulmonary Disease Lower Respiratory Disease

Interventions

Eligibility

Sex: ALLMin age: 18 YearsMax age: 75 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: sACOS patients * Previously participated in ULRS study and signed consent to be recontacted, or * Patient in the WTC EHC and signed consent to be recontacted * Onset of lower respiratory symptoms (LRS) after 9/11/01 * ACT \< 20 at WTC EHC Monitoring visit * Presence of LRS on Study Visit 1 * ACT\<20 at Study Visit 1 * FEV1 \> 70% predicted Study Visit 1 * Using ICS/LABA (Advair HFA equivalent \> 115/21 mcg bid) or Fluticasone (110 mcg bid or equivalent) for at least 1 month before Study Visit 1 * CXR without parenchymal abnormalities Control * Patient in the WTC EHC and signed consent to be recontacted * of lower respiratory symptoms on WTC EHC Monitoring Visit of WTC EHC * Absence of lower respiratory symptoms on Study Visit 1 * FEV1 \> 70% predicted on monitoring * Not on any ICS/LABA/LAMA Exclusion Criteria: sACOS * \>10py tobacco use * Unstable cardiac disease * Systolic BP \> 180 mmHg or Diastolic BP \> 120 mmHg * Oxygen saturation \< 90% * Uncontrolled HTN, DM * Musculoskeletal inability to exercise * Use of long acting muscarinic antagonist in the past 2 weeks * Current use of oral corticosteroids * Other pulmonary disease, including sarcoidosis, ILD * Currently pregnant or with plans to become pregnant or lactating * History of narrow angle glaucoma * Known prostate hyperplasia or bladder-neck obstruction Control * \>10py tobacco use * Unstable cardiac disease * Systolic BP \> 180 mmHg or Diastolic BP \> 120 mmHg * Oxygen saturation \< 90% * Uncontrolled HTN, DM * Musculoskeletal inability to exercise * Use of ICS/LABA/SABA/LAMA individually or in combined formulation * Current use of oral corticosteroids * Other pulmonary disease, including sarcoidosis, ILD * Currently pregnant or with plans to become pregnant or lactating * History of narrow angle glaucoma * Known prostate hyperplasia or bladder-neck obstruction

Outcomes

Primary Outcomes

Resting Lung Function using Spirometry following Forced Oscillation Techniques

functional impairment at rest and with increased respiratory frequency (spirometry and forced oscillation techniques; FOT).

Time frame: 4 Months

Measure of Lung Function using spirometry after inhalation of a targeted anti-muscarinic agent.

Spirometry (meaning the measuring of breath) is the most common of the pulmonary function tests (PFTs), measuring lung function, specifically the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled.

Time frame: 4 Months

Secondary Outcomes

Comparison of measure of serum marker IL-6

Inflammation is caused by extra protein released from the site of inflammation that circulates in the bloodstream. The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and plasma viscosity (PV) blood tests are commonly used to detect this increase in protein. In this way they are used as markers of inflammation.

Time frame: 4 Months

Comparison of measure of serum marker IL-8

Time frame: 4 Months

Comparison of measure of serum marker CRP

Time frame: 4 Months

Th2 inflammation By measure of fibrinogen

Time frame: 4 Months

Th2 inflammation By measure of periostin

Time frame: 4 Months

Small Airway Chronic Obstructive Disease Syndrome Following Exposure to WTC Dust

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes