Center for Deployment-Related Lung Disease

Respiratory Diseases in Post-9/11 Military Personnel Following Southwest Asia Deployment.

 Journal of Occupational and Environmental Medicine. 2020; 62:337-343.

Persistent respiratory symptoms following 9/11/2001 military deployment to Iraq and Afghanistan are common. Among patients seen at National Jewish Health’s Center for Deployment-Related Lung Disease, deployment-related distal lung disease, asthma, rhinitis, sinusitis, and intermittent laryngeal dysfunction/vocal cord dysfunction were frequently diagnosed. A comprehensive diagnostic approach may help identify a spectrum of respiratory diseases that requires a personalized approach to care.

Multiple Breath Washout: A Noninvasive Tool for Identifying Lung Disease in Symptomatic Military Deployers. 

Journal of Respiratory Medicine. 2021; 176:106281.

Multiple breath washout (MWB), a non-invasive breathing test used to detect large and small airways injury, was evaluated as a tool for detecting deployment-related lung disease in symptomatic military personnel. Deployers had significantly higher measures of ventilation inhomogeneity (non-uniform gas exchange in the lungs) compared to healthy controls. Patients with both distal disease and asthma had the most abnormal scores. Additionally, deployers who reported frequent exposure to explosive blasts during deployment had more abnormal scores.

Semi-Quantitative Chest CT Assessment Identifies Expiratory Central Airway Collapse in Symptomatic Military Personnel Deployed to Iraq and Afghanistan. 

Journal of Thoracic Imaging. 2021. In press.

A common airway finding in symptomatic military personnel returning from deployment is expiratory central airway collapse (ECAC). ECAC can be diagnosed on chest CT imaging with dynamic expiration. Among 62 deployers with persistent dyspnea (shortness of breath) that were evaluated in our clinic, 37% had ECAC. Three had severe (>85%) collapse. A standardized approach to CT-based assessment of ECAC should improve reliable diagnosis in patients with respiratory symptoms.

Particle Morphology and Elemental Analysis of Lung Tissue from Post-9/11 Military Personnel with Biopsy-Proven Lung Disease.

International Journal of Environmental Research and Public Health. 2023; 21(1):91.

There is a clear connection between some lung diseases occurring in previously deployed veterans and their military exposure to particulate matter (PM). In collaboration with scientists at the United States Geological Survey (USGS), National Jewish Health researchers examined the content of different elements -- silica, titanium, lead and other metals -- in lung tissue samples from veterans who have deployed since 2001. Compared to healthy control lung samples, veterans’ lung tissues had significantly higher levels of silica and silicate particles. This was particularly notable in those who served in combat environments. Study findings underscore the importance of minimizing dust exposures during deployment to protect the respiratory health of those in military service.

Small airways and airspace inflammation and injury distinguish lung histopathology in deployed military personnel from healthy and diseased lungs.

Human Pathology. February 2022. 

We used a computer-based scoring system to characterize histologic features of lung biopsies from 65 soldiers with persistent respiratory symptoms to those from 8 patients with chronic hypersensitivity pneumonitis (cHP), 10 with smoking-related respiratory bronchiolitis, 11 with autoimmune or post-transplant obliterative bronchiolitis, and 10 normal donor lungs. military service members were distinguished by a combination of small airways abnormalities including smooth muscle hypertrophy, peribronchiolar metaplasia, and lymphocytic inflammation, often with constrictive/obliterative and/or respiratory bronchiolitis, granulomatous inflammation, and moderate/severe emphysema (mainly in nonsmokers). Biopsies most strongly overlapped with cHP.

Quantitative imaging analysis detects subtle airway abnormalities in symptomatic military deployers.

BMC Pulmonary Medicine. April 2022; 22:163. 

Comparing quantitative chest imaging between symptomatic veterans and healthy controls, we found that quantitative imaging analysis identifies emphysema in veterans with asthma and distal lung disease, and may be useful in detecting and monitoring deployment-related lung disease in a population where spirometry is typically normal.

Unexplained Dyspnea Linked to Mitochondrial Myopathy Following Military Deployment to Southwest Asia and Afghanistan.

Physiological Reports. January 2023; 11:2. 

Examining cardiopulmonary exercise testing data from a large cohort of previously deployed veterans, we identified mitochondrial dysfunction as a possible cause of dyspnea and reduced exercise tolerance in a subset of previously deployed military personnel.

Deployment-Related Respiratory Disease: Where Are We? 

Semin Respir Crit Care Med. April 2023; 44(03): 370-377. 

This review aims to summarize our current understanding of deployment-related respiratory diseases (DRRD) and inform pulmonary practitioners of recent updates to DRRD screening, diagnosis, evaluation, and management. We also summarize guidance on conducting an occupational and deployment exposure history as well as recommendations for testing. Finally, we discuss the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act) that includes a list of health conditions that are “presumptively” considered to be related to SWA military deployment toxic exposures, and provide resources for clinicians who evaluate and treat patients with DRRD.

Longitudinal changes in lung function following post-9/11 military deployment in symptomatic veterans.

Respiratory Medicine. June 2024; 227,107638. 

In a cohort of symptomatic previously deployed military personnel, we examined longitudinal lung function testing and found that there was variation in lung function between diagnosis groups, with those that have both small and large airways disease most affected. We also found that those with more intense deployment exposures had worse lung function.

Dendriform pulmonary ossification in military combat veterans: A case series.

Respir Med Case Rep. 2024 Dec 25;53:102156. 

Dendriform pulmonary ossification (DPO) is a rare condition characterized by mature bone formation in the lung. We identified five combat veterans with DPO. All had deployed to Southwest Asia or Afghanistan during the First or Second Gulf War, and all reported frequent, intense exposure to diesel exhaust, burn pit emissions, and sandstorms. Lung function was abnormal in all cases. The most prevalent chest imaging and histopathology findings were airway-centric injury, inflammation, and retained particulate matter, suggesting substantial hazardous exposure during military deployment.