Occupational Lung Diseases among Soldiers Deployed to Iraq and Afghanistan

Abstract

Military personnel deployed to Iraq and Afghanistan, from 2004 to the present, has served in a setting of unique environmental conditions. Among these are exposures to burning trash in open air “burn pits” lit on fire with jet fuel JP-8. Depending on trash burned--water bottles, styrofoam trays, medical waste, unexploded munitions, and computers--toxins may be released such as dioxins and n-hexane and benzene. Particulate matter air pollution culminates from these fires and fumes. Additional environmental exposures entail sandstorms (Haboob, Shamal, and Sharqi) which differ in direction and relationship to rain. These wars saw the first use of improvised explosive devices (roadside phosphate bombs),as well as vehicle improvised explosive devices (car bombs), which not only potentially aerosolize metals, but also create shock waves to induce lung injury via blast overpressure. Conventional mortar rounds are also used by Al Qaeda in both Iraq and Afghanistan. Outdoor aeroallergens from date palm trees are prevalent in southern Iraq by the Tigris and Euphrates rivers, while indoor aeroallergen aspergillus predominates during the rainy season. High altitude lung disease may also compound the problem, particularly in Kandahar, Afghanistan. Clinically, soldiers may present with new-onset asthma or fixed airway obstruction. Some have constrictive bronchiolitis and vascular remodeling on open lung biopsy - despite having normal spirometry and chest xrays and CT scans of the chest. Others have been found to have titanium and other metals in the lung (rare in nature). Still others have fulminant biopsy-proven sarcoidiosis. We found DNA probe–positive Mycobacterium Avium Complex in lung from a soldier who had pneumonia, while serving near stagnant water and camels and goats outside Abu Gharib. This review highlights potential exposures, clinical syndromes, and the Denver Working Group recommendations on post-deployment health.

Comfort and exertion while using filtering facepiece respirators with exhalation valve and an active venting system among male military personnel

“…In recent military deployments in Iraq and Afghanistan, potential sources of particulates included the open-air burning of refuse, which can negatively affect the cardiorespiratory health of personnel. (19,20) In addition, deployment in areas with high levels of air pollution at baseline can also impair the cardiorespiratory performance of personnel. (21) While respiratory protection can be achieved via engineering and administrative controls, this may not always be possible.…”

Constrictive bronchiolitis presenting with a mixed obstructive and restrictive pattern, associated with acid reflux

“…The unique fumes the soldiers inhale have been questioned as possible causes in these cases. These include burning jet fuel, combustion of trash pits, sand from sandstorms, aerosolised metal from detonated Improvised Explosive Devices (IEDs) and mustard gas 7. Normal, everyday environmental exposures such as inhaling animal feed and cigarette smoke have also been reported to cause CB 8.…”

Irritants, Irritancy and Irritant Induced Asthma

“…Military Deployment, as a military-related exposure leading to newonset asthma, is a mischaracterization [160]. There is reference to "Iraq/Afghanistan War-Lung Injury".…”