Bronchitis in the Military: Diagnosis, Risk Mitigation, and Treatment
Abstract
Problem: Bronchitis is a common human disease currently only diagnosable by patient-reported symptoms, i.e., the experience of cough and sputum/phlegm production. Bronchitis can present in “acute” forms, usually reflecting the effects of viral infection and/or environmental exposures. Bronchitis can also evolve into a chronic form that typically reflects the persistence of exposure to a toxic material (e.g., cigarette smoke) or continued exposure to other environmental insults. If undiagnosed or not treated, chronic bronchitis can evolve into chronic obstructive pulmonary disease (COPD), the third leading cause of death in US Veterans and the civilian population. The central cause of the symptoms and disease manifestations of bronchitis is the production of a dehydrated, “thick,” and “sticky” mucus in the lungs. Typically, a fraction of the mucus accumulated in the lung can be coughed up, producing the symptoms of cough and sputum expectoration. Similarly, a fraction of the sticky mucus is retained in the lung, which blocks the flow of air throughout the airways, produces inflammation, and is the site for bacterial infection that often plagues subjects with bronchitis. From a patient perspective, accumulation of non-coughable mucus in the lung produces the feeling of “chest congestion.” The military environment is particularly suited to produce the syndrome of bronchitis by virtue of the relatively high rate of viral infections that occur in high density human environments, a significant rate of cigarette exposure, and intermittent exposure to inhaled military toxicants. At present, there are no means to make a diagnosis of bronchitis in the laboratory, rational insights into how to mitigate/prevent bronchitis, or thoughts on how to reverse the sticky mucus accumulation component of the bronchitis when it becomes manifest more chronically. Accordingly, there are needs in the Department of Defense (DoD) to: (1) have sensitive and specific tests to diagnose bronchitis and provide clues as to its cause; (2) understand how the mix of environmental toxicant exposures and viruses produces and accelerates bronchitis severity; (3) develop strategies to prevent or mitigate bronchitis; and (4) clear accumulated mucus from the lungs of subjects with chronic mucus accumulation and associated symptoms of cough and shortness of breath. Application/Impact: This Focus Program Award (FPA) will utilize novel medical concepts that address how sticky mucus forms in bronchitis to develop new methods to diagnose bronchitis and new thoughts on how to treat bronchitis to improve the health of military personnel and Veterans. For example, new diagnostic tests will be developed that will allow the military to discriminate people with bronchitis from those with healthy lungs. Such a test will assist in assessing the risk to military personnel as they enter potentially toxic environments, permit the military to assess whether or not exposure to a toxic environment has produced a bronchitic syndrome, and assess the risk that continued environmental exposure may have to produce irreversible disease progression. The FPA will also focus on studies designed to increase DoD knowledge of the mechanisms that may produce two broad forms of bronchitis, i.e., toxicant-induced vs. allergen-induced, and how these types of bronchitis interact with the intermittent viral infections that often drive progression/severity of bronchitis. The FPA’s mechanistic in vivo and in vitro studies will also explore novel insights in how to prevent and treat the various forms of bronchitis. Finally, the FPA will explore in human subjects strategies to reduce the likelihood of acquiring bronchitis in response to acute military-type toxicant exposures. Such preventative/reversal therapies likely could be used in the field as well as field hospital situations. Importantly, the FPA will test a novel therapy to clear the lungs of accumulated mucus in personnel with m
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1810731
Entities
People
- Richard Boucher
Organizations
- United States Army
- University of North Carolina at Chapel Hill