Military Examines Lung Issues

Military officials were not present at the recent congressional hearing. Col. Lisa L. Zacher, M.D., pulmonary consultant to the U.S. Army Surgeon General, and Dr. Coleen Baird, M.D., MPH, program manager for Environmental Medicine at the U.S. Army Public Health Command, told U.S Medicine in a written statement said the Army and DoD is taking “a serious but standardized and comprehensive approach” to identifying, defining and determining pulmonary disorders that could be related to deployment.

However, they said the military does not believe that respiratory issues will be a problem for most troops serving in Iraq and Afghanistan.

“Indications are that the vast majority of OIF/OEF veterans will not have significant lung problems, but we intend to identify and characterize those with definitively diagnosed pulmonary disease,” they said. “Those who ultimately develop disease will be dependent not only on type and extent of exposure but on co-morbidities (e.g., pre-existent asthma), concomitant exposures (e.g., tobacco use) and genetic pre-disposition.”

Zacher and Baird cited preliminary results of clinical and animal studies that were proposed by a working group convened by DoD. Those results do  not suggest that deployment or exposure to Southwest Asian environmental dusts is generally associated with severe chronic lung disease, although dust exposure may well aggravate pre-existing asthma, they said.

They also questioned the CB research outlined by King and Miller.

“…A small number of servicemembers and veterans (currently around 50) have been diagnosed with constrictive bronchiolitis,” they wrote. “This severe lung disease has been proposed to result from inhalational exposures while these servicemembers were deployed; however, there is not a clear link between a type of exposure known to cause the disease and the history of some of these patients. The DoD is working with academic researchers to improve diagnosis of the disease and to identify possible causes of disease.”

Cecile Rose, MD, MPH at National Jewish Medical Center in Denver is leading a blinded pathological review of tissue from the Vanderbilt and other potential deployment-related Interstitial Lung Disease cases, Zacher and Baird said.

Zacher and Baird said a working group also has recommended pre- and post-deployment pulmonary function testing of troops. DoD believes, however, that pre- and post-deployment spirometry of asymptomatic individuals is “probably not warranted” and that physical fitness testing of troops serves as an indirect measure of pulmonary function and should identify individuals who have respiratory complaints. 

“We believe that pre- and post-deployment spirometry of asymptomatic individuals in a relatively healthy population is probably not warranted,” they wrote. “However, we agree that a baseline pulmonary function test of servicemembers would be useful to assess a servicemember longitudinally in the event of new symptoms or concerns. We also are very aware of the logistical challenges that would need to be overcome.”

Zacher and Baird also said DoD  is considering identifying several military treatment facilities as referral centers for difficult or complex respiratory cases after standard evaluations. 

“We believe that Centers of Excellence within DoD or outside of DoD would serve to consolidate such cases and increase our understanding of the nature and magnitude of respiratory conditions in our forces,” they said.

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