Pulmonary and Inflammatory Responses Following Exposure to a Low Concentration of Ozone or Clean Air (LOCONOZ2)

Pulmonary and Inflammatory Responses Following Exposure to a Low Concentration of Ozone or Clean Air for 6.6 Hours With Moderate Exercise in Healthy Young Adults

Purpose: The primary purpose of this study is to measure pulmonary function, symptoms, and pulmonary inflammatory responses in healthy young adults during and immediately after exposure to a low concentration of ozone (0.070 ppm) or clean air for 6.6 hours while undergoing moderate intermittent exercise. This concentration is the current EPA NAAQS standard for ozone.

Study Overview

• Status: Recruiting
• Conditions: Symptoms and Signs; Lung Injury, Acute; Neutrophilia Acute
• Intervention / Treatment: Biological: 0.070 ppm ozone concentration; Biological: Clean air (0.0 ppm ozone)

Detailed Description

Potential health effects of ozone have been extensively studied over decades at various levels of exposure concentration and for varying time periods in young healthy adult subjects. Effects of ozone have been well documented particularly for decrements of lung function and an influx of neutrophils and other markers of pulmonary inflammation. The majority of those studies were done at ozone concentrations between 0.12 and 0.40 ppm, considerably higher than the current EPA NAAQS ozone standard of 0.070 ppm, and at exposure durations of two hours, even though the current standard is an 8-hour standard. However, a small number of studies have assessed changes in lung function following exposure to low levels of ozone for several hours. These latter studies have shown that exposure to ozone for 6.6 hours at concentrations between 0.06 and 0.08 ppm causes mild reversible decrements in lung function (1.7-10%) as measured by forced vital capacity (FVC) and forced expired volume at 1 s (FEV1) immediately after exposure in healthy young adults. In addition, in one study an increase in ozone-induced neutrophils was seen in induced sputum following exposure to 0.06 ppm ozone (8) and in bronchoalveolar lavage fluid) following exposure to 0.08 ppm ozone (9). The EPA is considering whether the current ozone NAAQS standard at 0.070 is protective and has asked EPA researchers to conduct a study similar to those done at 0.06 and 0.08 ppm.

• Study Type: Interventional
• Enrollment (Anticipated): 60
• Phase: Phase 1

Contacts and Locations

• Study Contact: Name: Martin W Case, B.S.; Phone Number: 919-966-6211; Email: case.martin@epa.gov
• Study Contact Backup: Name: Andrea Davis, R.N.; Phone Number: 919-966-6241; Email: davis.andrea@epa.gov

Study Locations

• United States
  • North Carolina
    • Chapel Hill, North Carolina, United States, 27599-7315
      • Recruiting
      • EPA Human Studies Facility
      • Contact: Al Little; Phone Number: 919-966-5884; Email: little.al@epa.gov
      • Sub-Investigator: Ana Rappold, Ph.D.

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 35 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Healthy men and women between 18 and 35 years of age.
2. Physical conditions allowing sustained moderate exercise for 6.6 hours.

3. Normal lung function (NHANES III):

   1. FVC > 80 % of that predicted for gender, ethnicity, age and height.
   2. FEV1 > 80 % of that predicted for gender, ethnicity, age and height.
   3. FEV1/FVC ratio > 80 % of predicted values
4. Oxygen saturation > 94 %.
5. Total symptom Score no greater than 20 (out of a possible 60-see accompanying score sheet) with a value no greater than 3 for any one score. No more than one score may be equal to 3.

Exclusion Criteria:

1. Individuals with a diagnosis of COVID-19 and/or hospitalized for COVID-19.
2. Individuals who are not "up to date," [meaning a person has received all recommended COVID-19 vaccines, including any booster dose(s) when eligible with their COVID vaccines as defined by the CDC.]
3. A history of acute and chronic cardiovascular disease, chronic respiratory disease, diabetes,rheumatologic diseases, immunodeficiency state.
4. An acute respiratory illness within 4 weeks.
5. Subjects who are asthmatic or have a history of asthma.
6. Allergic to chemical vapors or gases.
7. Any allergic symptoms during the time of participation in the study
8. Female subjects who are currently pregnant, attempting to become pregnant or breastfeeding
9. Subjects currently taking mega doses of vitamins and supplements, homeopathic/naturopathic medicines or medications which may impact the results of the ozone challenge or interfere with any other medications potentially used in the study (to include systemic steroids and beta blockers). Medications not specifically mentioned here may be reviewed by the investigators prior to a subject's inclusion in the study.
10. Current and past smokers within 2 years, or subjects with a smoking history of at least a pack of cigarettes a day for more than 10 years over your lifetime. This includes vaping, hookah,and e-cigarettes.
11. Uncontrolled hypertension (> 140 systolic, > 90 diastolic). Blood pressure readings equal to or greater that 140 Systolic and equal to or greater that 90 diastolic.
12. Subjects who do not understand or speak English
13. Unspecified illnesses, which in the judgment of the investigator might increase the risk associated with ozone inhalation challenge or exercise, will be a basis for exclusion.

Temporary exclusion criteria:

1. Individuals who have had an acute respiratory illness within 4 weeks.
2. Individuals who have active allergies.
3. Individuals that have engaged in strenuous exercise within 24 hours of any study visit.
4. Individuals unable to avoid drinking alcohol for 24 hours prior to all study visits.
5. Individuals who have been exposed to smoke and fumes for 24 hours before all visits.
6. Individuals that have used an ozone-based home air purifier for 24 hours before all visits.
7. Individuals that have eaten or drank anything for 2 hours prior to the sputum training/screening day visit.
8. Individuals should avoid caffeine for 12 hours prior to all study visits.
9. Individuals should refrain from all over the counter anti-inflammatory agents including those for allergies, and anti-inflammatory drugs or antioxidants for a period of one week prior to the train and to the exposure.

10. Individuals that have been exposed to or have consumed any agent or have undertaken any activity within 24 hours of any study visit that the investigators believe may compromise the results of the study.

    -

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: 0.070 ppm ozone concentration; Exposure to 0.070 ppm ozone for 6.6 hours while performing moderate intermittent exercise.	Biological: 0.070 ppm ozone concentration; The concentration of ozone a subject will randomly receive on a visit for 6.6 hours in a controlled atmospheric chamber while performing moderate intermittent exercise.
Experimental: Clean air (0.0 ppm ozone); Exposure to clean air (0.0 ppm ozone) for 6.6 hours while performing moderate intermittent exercise.	Biological: Clean air (0.0 ppm ozone); Same subject will randomly receive clean air on another visit separated by at least one week for 6.6 hours in the same controlled atmospheric chamber while performing moderate intermittent exercise.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
FVC	forced vital capacity	measured (pre) before starting 6.6 hours of exercise
Change in FVC	change in forced vital capacity	change measured (post) immediately after 6.6 hours of exercise
FEV1	forced expiratory volume in 1 second	measured (pre) before starting 6.6 hours of exercise
Change in FEV1	change in forced expiratory volume in 1 second	change measured (post) immediately after 6.6 hours of exercise

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
% neutrophils collected by induced sputum	Subjects will breathe a hypertonic saline solution from an ultrasonic nebulizer through a mouthpiece at saline concentrations of 3%, 4%, and 5%. After each inhalation period subjects be asked to cough up the expectorate in a sterile cup for analysis of neutrophil cells influx	baseline: training/qualification day
change in % neutrophils collected by induced sputum	Subjects will breathe a hypertonic saline solution from an ultrasonic nebulizer through a mouthpiece at saline concentrations of 3%, 4%, and 5%. After each inhalation period subjects be asked to cough up the expectorate in a sterile cup for analysis/quantitation of neutrophil cells influx	18 hours post exposure

Collaborators and Investigators

• Sponsor: Martin W. Case
• Collaborators: University of North Carolina
• Investigators: Principal Investigator: Andy Ghio, M.D., EPA/ORD/CPHEA/PHITD/CRB

Study record dates

Study Major Dates

• Study Start (Actual): October 13, 2022
• Primary Completion (Anticipated): February 1, 2024
• Study Completion (Anticipated): February 1, 2025

Study Registration Dates

• First Submitted: December 16, 2022
• First Submitted That Met QC Criteria: January 9, 2023
• First Posted (Estimate): January 11, 2023

Study Record Updates

• Last Update Posted (Estimate): January 11, 2023
• Last Update Submitted That Met QC Criteria: January 9, 2023
• Last Verified: January 1, 2023

More Information

Terms related to this study

• Keywords: exercise; inflammation; symptoms; lungs; ozone concentration
• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Lung Diseases; Wounds and Injuries; Thoracic Injuries; Acute Lung Injury; Lung Injury
• Other Study ID Numbers: IRB# 21-3193

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No