Study of Active Duty Military Personnel for Environmental Deployment Exposures: Pre- and Post-Deployment Spirometry (STAMPEDE II)

Abstract

BACKGROUND: There is significant concern about the respiratory health of deployed military service members given the reported airborne hazards in southwest Asia, which range from geologic dusts, burn pit emissions, chemical exposures, and increased rates of smoking. There has been no previous comparison of pre-and post-deployment lung function in these individuals. METHODS: Military personnel who deployed to southwest Asia in support of ongoing military operations were recruited from the Soldier Readiness Processing Center at Fort Hood, Texas, from 2011 to 2014. The participants were asked to complete a brief survey on their respiratory health and perform both spirometry and impulse oscillometry studies at baseline with repeated survey and testing after deployment. RESULTS: Of the 1,693 deployed personnel who completed baseline examinations, 843 (50%) completed post-deployment testing. Post-deployment values demonstrated no statistical or clinical change in spirometry, with an increase in mean ؎ SD FEV 1 (% predicted) from 95.2 ؎ 12.6 to 96.1 ؎ 12.4 (P ‫؍‬ .14), increase in mean ؎ SD FVC (% predicted) from 95.9 ؎ 11.8 to 96.4 ؎ 11.9 (P ‫؍‬ .32), and increase in mean ؎ SD FEV 1 /FVC from 81.5 ؎ 5.9 to 81.8 ؎ 6.1 (P ‫؍‬ .29). Impulse oscillometry values showed statistical improvement with reduction in resistance (at 5 Hz and 20 Hz) and reactance (at 5 Hz). The presence of pre-deployment obstruction, self-reported asthma, smoking history, or increased body mass index also did not change spirometry values after deployment. DISCUSSION: To our knowledge, this was the first prospective evaluation of deploying military by using spirometry as an indicator for the possible development of pulmonary disease related to environmental exposures. Pre-deployment testing with spirometry and impulse oscillometry was unable to detect any significant change. In those with abnormal spirometry pre-deployment or asthma history, there was also not identifiable change that indicated worsening lung function. CONCLUSIONS: Utilization of spirometry for the deploying military population had little benefit and did not identify individuals with lung disease after deployment. Routine use was not warranted before or after deployment in the absence of pulmonary symptoms.

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

“…Indeed, trying to predict which military personnel are at risk for developing chronic respiratory issues has been evaluated in prior studies with mixed results. 2,7,13 The STAMPEDE II (Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy) trial showed no significant difference in pre-and post-deployment spirometry and impulse oscillometry, including those who had baseline abnormal spirometry or asthma history. 7 The STAMPEDE III trial classified 32% of their subjects as having undiagnosed exertional dyspnoea with normal studies.…”

“…[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.…”

Individual Variation of Spirometry Before and After Deployment From the STAMPEDE II Cohort

“…This brief correspondence is to address concerns regarding our manuscript, "Study of Active Duty Military Personnel for Environmental Deployment Exposures: Before and After Deployment Spirometry (STAMPEDE II)" by Morris et al published in the May 2019 issue of RESPIRATORY CARE. 1 Questions have been raised in several forums regarding the statistical analysis used in the original article. The original data involved the longitudinal collection of spirometry and impulse oscillometry values from soldiers prior to and after deployment to the theater of operations in southwest Asia.…”

“…The original data in the article were in fact analyzed using a paired t test approach, which takes advantage of the correlation between before and after deployment measures. 1 This was incorrectly reported as a Student t test in the article.…”

“…We read with great interest the paper describing the randomized controlled trial performed by Windm€ oller et al, 1 in which they investigated the effect of physical exercise combined with CPAP in cardiac bypass surgery. They reported that a combination of physical exercise and CPAP increased pre-and postoperative distance covered in the 6-min walk test (6MWT) and the length of stay in the ICU among subjects undergoing coronary artery bypass graft surgery.…”