Comprehensive Evaluation of Military Personnel With Postdeployment Respiratory Symptoms

Abstract

PURPOSE: Studies of military personnel deployed to Operations Iraqi Freedom and Enduring Freedom have suggested an increase in chronic lung disease due to environmental exposures. Findings are based primarily on increased respiratory symptoms and retrospective data. Our previous study (STAMPEDE I) did not identify any acute interstitial or inflammatory process. The study objective was to complete a comprehensive evaluation of active duty military with deployment-related pulmonary symptoms and identify etiology of symptoms. METHODS: Military personnel referred for deployed-related respiratory symptoms underwent a standardized evaluation at our institution. Initial studies included laboratory tests, HRCT imaging, cardiac evaluation with ECG, and echocardiography. Pulmonary function testing consisted of full PFTS, forced inspiratory/expiratory pressures, post-spirometry bronchodilator testing, and impulse oscillometry (IOS) performed in accordance with ATS standards. Further testing included methacholine, laryngoscopy, cardiopulmonary testing, and bronchoscopy with bronchoalveolar lavage sent for cell count and flow cytometry. RESULTS: Completed evaluations of the initial 38 patients have yielded a variety of diagnoses. Patients were 89% male and 11% female with a mean age of 37.0 +/- 9.5 years and BMI of 28.6 +/- 4.2. Nearly 45% had a smoking history and 36% smoked during deployment. Mean PFTs revealed an FEV1 (% predicted) of 87.6 +/- 14.4 and FVC (% predicted) of 97.1 +/- 14.4. Mean lung volumes, residual volumes, and diffusing capacities were 100% predicted. Eleven patients had positive methacholine testing and 5 patients were had abnormal findings during exercise laryngoscopy. Most common diagnoses included asthma (n=7), EIB (n=5), chronic cough (n=5), GERD (n=5), VCD (n=5), and negative evaluations (n=9). CONCLUSIONS: This comprehensive evaluation of post-deployment pulmonary symptoms identified a variety of chronic pulmonary diseases and several cardiac etiologies. Similar to previous studies, 25% had a negative comprehensive evaluation. There was a lack of findings suggesting chronic interstitial diseases or evidence of occupational lung disease that could be linked to geologic dusts or burn pit smoke exposure.