Respiratory Health after Military Service in Southwest Asia and Afghanistan. An Official American Thoracic Society Workshop Report

Abstract

Since 2001, more than 2.7 million U.S. military personnel have been deployed in support of operations in Southwest Asia and Afghanistan. Land-based personnel experienced elevated exposures to particulate matter and other inhalational exposures from multiple sources, including desert dust, burn pit combustion, and other industrial, mobile, or military sources. A workshop conducted at the 2018 American Thoracic Society International Conference had the goals of: 1 ) identifying key studies assessing postdeployment respiratory health, 2 ) describing emerging research, and 3 ) highlighting knowledge gaps. The workshop reviewed epidemiologic studies that demonstrated more frequent encounters for respiratory symptoms postdeployment compared with nondeployers and for airway disease, predominantly asthma, as well as case series describing postdeployment dyspnea, asthma, and a range of other respiratory tract findings. On the basis of particulate matter effects in other populations, it also is possible that deployers experienced reductions in pulmonary function as a result of such exposure. The workshop also gave particular attention to constrictive bronchiolitis, which has been reported in lung biopsies of selected deployers. Workshop participants had heterogeneous views regarding the definition and frequency of constrictive bronchiolitis and other small airway pathologic findings in deployed populations. The workshop concluded that the relationship of airway disease, including constrictive bronchiolitis, to exposures experienced during deployment remains to be better defined. Future clinical and epidemiologic research efforts should address better characterization of deployment exposures; carry out longitudinal assessment of potentially related adverse health conditions, including lung function and other physiologic changes; and use rigorous histologic, exposure, and clinical characterization of patients with respiratory tract abnormalities.

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.…”

“…[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. This is explained as being due primarily to the low frequency of lung biopsies in clinical studies regarding deployed personnel, and therefore the ability to study histological findings.…”

“…1 Recent evidence has shown that many of these individuals were exposed to hazardous respiratory inhalants while on deployment. 2,3 This can include emissions from burn pits, desert dust particulate matter, vehicular emissions, oil well fires, chemical weapons, pesticides, explosives and industrial pollutants. In addition, studies have shown that soldiers deployed to Southwest Asia are at an increased risk of developing respiratory 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.…”

Military Deployment and Respiratory Symptoms

“…Sources included open-air waste burning (burn pits) at bases, desert dust, vehicle exhaust, military operations, and poorly regulated local industrial sources. 1 Sampling in deployment areas indicated elevated 24-h PM 2.5 (PM # 2.5 mm in diameter) mean annual values (~40 mg/m 3 to nearly 120 mg/m 3 ). 2 Other studies have also identified levels far exceeding the US ambient annual PM 2.5 standard of 12 mg/m 3 .…”