Overview and Recommendations for Medical Screening and Diagnostic Evaluation for Postdeployment Lung Disease in Returning US Warfighters

Rose, Cecile S.; Abraham, Joseph H.; Harkins, Deanna; Miller, Robert F.; Morris, Michael J.; Zacher, Lisa L.; Meehan, Richard T.; Szema, Anthony M.; Tolle, James; King, Michael; Jackson, David A.; Lewis, John A.; Stahl, Andrea; Lyles, Mark; Hodgson, Michael; Teichman, Ronald; Salihi, Walid; Matwiyoff, Gregory; Meeker, Gregory P.; Mormon, Suzette; Bird, Kathryn; Baird, Coleen P.

doi:10.1097/jom.0b013e31825297ba

Cited by 40 publications

(26 citation statements)

References 16 publications

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“…The Denver Working Group on Post-Deployment Health paper in an issue of the JOEM provides expert recommendations to promote surveillance pre- and post-deployment in regions of conflict, such as Iraq and Afghanistan [15]. The recommendations take into account risks of new-onset asthma and bronchiolitis.…”

Section: Future Research Trendsmentioning

confidence: 99%

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Occupational Lung Diseases among Soldiers Deployed to Iraq and Afghanistan

Szema

2013

Occup Med Health Aff

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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.

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Section: Future Research Trendsmentioning

confidence: 99%

“…A key conclusion of the Denver Working Group is that there is a need for targeted, practical medical surveillance for lung diseases and for a standardized diagnostic approach for all symptomatic deployed personnel [15] (Tables 1-3). …”

Section: Future Research Trendsmentioning

confidence: 99%

Occupational Lung Diseases among Soldiers Deployed to Iraq and Afghanistan

Szema

2013

Occup Med Health Aff

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“…Larger population-based samples of veterans are therefore necessary to confirm our findings; however, our data do support prior recommendations to perform bronchodilator spirometry in deployed veterans regardless of prebronchodilator performance. 10 It should also be noted that standard clinical criteria for bronchodilator responsiveness were utilized in the present study, 21 yet other studies have used different and perhaps more liberal criteria including post-bronchodilator increases in peak expiratory flow (PEF) at least 15% and mid-expiratory flow (FEF ) at least 35%. 26 Had these alternative criteria been employed in the present study, approximately 42% would have demonstrated a positive bronchodilator response despite having normal pre-bronchodilator spirometry, as compared with 17% using FEV 1 and FVC criteria alone.…”

Section: Discussionmentioning

confidence: 97%

“…[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.…”

mentioning

confidence: 98%

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

Falvo

Abraham

Osinubi

et al. 2016

Journal of Occupational &Amp; Environmental Medicine

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“…The convened group included civilian and military experts in airborne hazards and respiratory diseases, and examined the limited available evidence to develop a general consensus for further investigations. Some general recommendations included conducting standardized pre-and postdeployment medical surveillance; establishing criteria for medical referral and diagnosis; and developing case definitions for key deployment-related lung diseases [Rose et al 2012]. It was clear that a coordinated effort to resolve issues related to deployment-related respiratory disease would be required because available data were limited.…”

Section: Development Of a Pulmonary Health Research Programmentioning

confidence: 99%

Diagnosis and management of chronic lung disease in deployed military personnel

Morris

Lucero

Zanders

et al. 2013

Ther Adv Respir Dis

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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.

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Overview and Recommendations for Medical Screening and Diagnostic Evaluation for Postdeployment Lung Disease in Returning US Warfighters

Abstract: There is a need for targeted, practical medical surveillance for lung diseases and for a standardized diagnostic approach for all symptomatic deployed personnel.

Cited by 40 publications

References 16 publications

Occupational Lung Diseases among Soldiers Deployed to Iraq and Afghanistan

Occupational Lung Diseases among Soldiers Deployed to Iraq and Afghanistan

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

Diagnosis and management of chronic lung disease in deployed military personnel

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