Respiratory Diseases in Post-9/11 Military Personnel Following Southwest Asia Deployment

Abstract

Objective: Persistent respiratory symptoms following post-9/11 military deployment to Iraq and Afghanistan are well-recognized, but the spectrum of respiratory diseases remains poorly characterized. This study describes deployment-related respiratory diseases and the diagnostic utility of resting and exercise pulmonary function testing. Methods: Between 2009 and 2017, 127 consecutive military workers (“deployers”) with new-onset respiratory symptoms underwent clinical evaluation. Deployment-related respiratory diseases were classified as proximal and/or distal. Using descriptive statistics and logistic regression, we analyzed lung function parameters associated with deployment-related distal lung disease (DDLD). Results: Common deployment-related respiratory diseases included asthma (31.5%), intermittent laryngeal obstruction (14.2%), rhinosinusitis (15%), and DDLD (68.5%). Decreased diffusion capacity (odds ratio [OR] = 4.6, 95% confidence interval [CI]: 1.4 to 15.1, P = 0.01) was significantly associated with DDLD. Conclusions: A comprehensive diagnostic approach may identify a spectrum of proximal and distal respiratory diseases that can occur in symptomatic post-9/11 deployers, requiring a personalized approach to care.

Semiquantitative Chest Computed Tomography Assessment Identifies Expiratory Central Airway Collapse in Symptomatic Military Personnel Deployed to Iraq and Afghanistan

“…Our findings suggest that TBM and EDAC are more common than previously recognized in military personnel who return from deployment to southwest Asia and Afghanistan with persistent respiratory symptoms. 1 , 2 Notably, the odds of developing tracheal abnormalities appear to increase with each additional year of deployment to these austere environments.…”

Quantitative imaging analysis detects subtle airway abnormalities in symptomatic military deployers

“…Deployers were classified as those with definite deployment-related lung disease including those with deployment-related asthma (DRA) and/or biopsy-proven deployment-related distal lung disease (DDLD, n = 24). Case definitions are detailed in a previous study [ 6 ]. Briefly, we defined biopsy-proven DDLD based on a pulmonary pathologist’s identification of abnormal distal lung histologic findings of bronchiolitis, granulomatous pneumonitis, and/or hyperinflation with emphysema on surgical lung biopsy.…”

“…Inhalation of hazardous particulate matter from burn pit emissions, desert dust, occupational vapors, dusts, gases, and fumes (VDGF), explosive blasts, and diesel exhaust during deployment to Iraq, Afghanistan, and other Southwest Asia locations may place deployed military personnel (‘deployers’) at increased risk for respiratory diseases [ 1 – 5 ]. Deployment-related asthma, bronchiolitis, and persistent, sometimes career-ending, respiratory symptoms have been reported in those who deployed to these hazardous environments since September 11, 2001 [ 6 – 14 ]. Pulmonary function tests and qualitative visual assessment of high resolution computed tomography (HRCT) findings are often normal or nonspecific, and more sensitive diagnostic markers of lung disease are needed.…”

Multiple breath washout: A noninvasive tool for identifying lung disease in symptomatic military deployers

“…Following deployment to Southwest Asia and Afghanistan since September 11 th , 2001, an unknown number of military personnel ("deployers") developed persistent and sometimes disabling respiratory symptoms, some due to bronchiolitis and asthma (1)(2)(3)(4)(5). While deployed, many report exposure to high concentrations of particulate matter from sandstorms, diesel combustion, and burning waste (6)(7)(8)(9)(10) that can cause airway injury.…”

“…Deployment-related respiratory disease clinical findings are often nonspecific, particularly in those with indolent constrictive bronchiolitis on thoracoscopic lung biopsy (1,4). Because lung biopsy is expensive, invasive and poses risks, noninvasive tools for diagnosis of indolent small airways injury are needed.…”