Congressional Testimony Fuels Debate on Deployment-Related Respiratory Disease

WASHINGTON — A pulmonary physician recently testified at a Senate subcommittee hearing about the number of troops returning from Iraq and Afghanistan with moderate to severe respiratory diseases, underscoring the growing debate about whether deployment to those theaters of operations increases the risk of developing lung problems.

Sgt. Robert B. Brown supervises at a burn pit at Camp Fallujah in the Al Anbar Province of Iraq as smoke and flames rise into the night sky behind him, May 2007. (Photo courtesy of USMC, photographer Cpl. Samuel D. Corum)

“There have been several studies reporting a startling number of respiratory disorders in personnel returning from Iraq and Afghanistan,” said Matthew King, MD, who has treated veterans and troops at Vanderbilt University Medical Center and the VA Medical Center in Nashville.

King testified on behalf of the American Thoracic Society and was among representatives from 22 non-DoD organizations and advocacy groups who spoke to the Senate Defense Appropriations Subcommittee about a range of issues that they believed should be addressed in DoD’s FY 2012 budget.

Respiratory Problems In Troops

King, whose descriptive case series on the issue was published last month in the New England Journal of Medicine,  said that pulmonologists are “deeply concerned” about the respiratory issues that some military personnel are suffering, such as constrictive bronchiolitis (CB). Patients with this condition, he said, often have normal pulmonary function tests, yet suffer severe respiratory symptoms.

King said troops in Iraq and Afghanistan are faced with a barrage of respiratory insults, “ranging from dust storms to inhaled smoke from burn pits to aerosolized metal and chemicals from exploding IEDS, blast overpressure or shock waves to the lung, outdoor aero-allergens such as date pollen and indoor aero-allergens such as mold aspergillus.”

One issue complicating research is that deployed troops do not receive pre- and post- deployment pulmonary function tests that could help doctors know the extent of lung damage, he said. ATS is recommending that DoD begin giving those function tests to all deployed military personnel. King also said ATS is recommending that VA and DoD jointly create and fund a program to study respiratory exposures of troops deployed to Iraq and Afghanistan, and that a center of excellence be developed by DoD to facilitate improved research and clinical treatment of troops experiencing severe deployment-related respiratory illnesses.

Charles Connor, president and CEO of the American Lung Association (ALA), also told the subcommittee his organization was “extremely concerned” about respiratory diseases affecting soldiers and marines coming back from theater are experiencing. Connor also suggested that military personnel needed to be tested for respiratory and lung function pre-deployment so that doctors can make useful comparison with post-deployment results, instead of comparing soldiers to the population average.

Their concerns were similar to those voiced by Vanderbilt University pulmonologist Robert Miller, MD, at a Senate hearing in October 2009. Miller said then that Vanderbilt began, in early 2004, to receive referrals from providers at Fort Campbell who were asking for assistance in evaluating soldiers who complained of shortness of breath on exertion and could no longer pass physical fitness testing. Routine tests could not explain the cause for the soldiers’ limitations. Their CB diagnosis was eventually established at Vanderbilt by surgical lung biopsy, he said.

“The typical soldier previously had been able to complete a two-mile run within regulation time, but now had to walk much of the course,” Miller said in written testimony at the time. “In almost all cases, standard respiratory evaluations obtained at Fort Campbell had been normal, including chest X-rays, chest CT scans and pulmonary-function testing.”

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