Diagnosis and management of chronic lung disease in deployed military personnel

Abstract

Abstract:Military personnel are a unique group of individuals referred to the pulmonary physician for evaluation. Despite accession standards that limit entrance into the military for individuals with various pre-existing lung diseases, the most common disorders found in the general population such as asthma and chronic obstructive pulmonary disease remain frequently diagnosed. Military personnel generally tend to be a more physically fit population who are required to exercise on a regular basis and as such may have earlier presentations of disease than their civilian counterparts. Exertional dyspnea is a common complaint; establishing a diagnosis may be challenging given the subtle nature of symptoms and lack of specificity with pulmonary function testing. The conflicts over the past 10 years in Iraq and Afghanistan have also given rise to new challenges for deployed military. Various respiratory hazards in the deployed environment include suspended geologic dusts, burn pits, vehicle exhaust emissions, industrial air pollution, and isolated exposure incidents and may give rise to both acute respiratory symptoms and chronic lung disease. In the evaluation of deployed military personnel, establishing the presence of actual pulmonary disease and the relationship of existing disease to deployment is an ongoing issue to both military and civilian physicians. This paper reviews the current evidence for chronic lung disease in the deployed military population and addresses any differences in diagnosis and management.

Non‐necrotizing granulomatous pneumonitis and chronic pleuritis in soldiers deployed to Southwest Asia

“…Despite the uncertainty in the medical literature, unexplained respiratory symptoms occurring in soldiers deployed to Southwest Asia has been well described. [1][2][3][4] It has also been recognised that landbased personnel deployed to countries in Southwest and Central Asia, such as Iraq, Afghanistan, Kuwait, Qatar and the United Arab Emirates, may have been exposed to harmful particulate matter and respiratory pollutants. 3 However, there has been a paucity of data defining the histological features behind these pulmonary symptoms.…”

“…In addition, studies have shown that soldiers deployed to Southwest Asia are at an increased risk of developing respiratory symptoms. [1][2][3][4][5][6] Confounding factors, such as predeployment exposures and undiagnosed pulmonary conditions, contribute to the difficulty in exploring this association. [6][7][8] The correlation of deployment to Southwest Asia with chronic lung disease continues to be studied.…”

Bronchodilator Responsiveness and Airflow Limitation Are Associated With Deployment Length in Iraq and Afghanistan Veterans

“…[3][4][5] Although military personnel may be uniquely vulnerable and susceptible to airborne hazards, 6 a causal relationship between deploymentrelated exposures and respiratory disease has not been established in recent combat veterans. Despite several reviews, 3,6-8 recommendations, 3,9,10 and the launch of a national registry database, 11 few studies are available that document objective pulmonary function among veterans who had deployed to Southwest Asia. [12][13][14] At present, the literature is composed predominantly of retrospective studies and surveys, which have recently been reviewed elsewhere.…”

Airborne Dioxins, Furans, and Polycyclic Aromatic Hydrocarbons Exposure to Military Personnel in Iraq

“…Despite studies reporting that the BP practice do not constitute an elevated risk for human health, this conclusion is still heavily debated, mostly because toxicological, epidemiological and clinical data are not yet adequate to reliably evaluate the prevalence or severity of adverse effects of inhalational exposures to BP exhausts in military personnel. 34,35 …”