Constrictive Bronchiolitis in Soldiers Returning from Iraq and Afghanistan
- 21 July 2011
- journal article
- research article
- Published by Massachusetts Medical Society in New England Journal of Medicine
- Vol. 365 (3), 222-230
- https://doi.org/10.1056/nejmoa1101388
Abstract
In this descriptive case series, 80 soldiers from Fort Campbell, Kentucky, with inhalational exposures during service in Iraq and Afghanistan were evaluated for dyspnea on exertion that prevented them from meeting the U.S. Army's standards for physical fitness. The soldiers underwent extensive evaluation of their medical and exposure history, physical examination, pulmonary-function testing, and high-resolution computed tomography (CT). A total of 49 soldiers underwent thoracoscopic lung biopsy after noninvasive evaluation did not provide an explanation for their symptoms. Data on cardiopulmonary-exercise and pulmonary-function testing were compared with data obtained from historical military control subjects. Among the soldiers who were referred for evaluation, a history of inhalational exposure to a 2003 sulfur-mine fire in Iraq was common but not universal. Of the 49 soldiers who underwent lung biopsy, all biopsy samples were abnormal, with 38 soldiers having changes that were diagnostic of constrictive bronchiolitis. In the remaining 11 soldiers, diagnoses other than constrictive bronchiolitis that could explain the presenting dyspnea were established. All soldiers with constrictive bronchiolitis had normal results on chest radiography, but about one quarter were found to have mosaic air trapping or centrilobular nodules on chest CT. The results of pulmonary-function and cardiopulmonary-exercise testing were generally within normal population limits but were inferior to those of the military control subjects. In 49 previously healthy soldiers with unexplained exertional dyspnea and diminished exercise tolerance after deployment, an analysis of biopsy samples showed diffuse constrictive bronchiolitis, which was possibly associated with inhalational exposure, in 38 soldiers.This publication has 25 references indexed in Scilit:
- New-onset asthma among soldiers serving in Iraq and AfghanistanAllergy and Asthma Proceedings, 2010
- Newly Reported Respiratory Symptoms and Conditions Among Military Personnel Deployed to Iraq and Afghanistan: A Prospective Population-based StudyAmerican Journal of Epidemiology, 2009
- Small Airway Remodeling in Idiopathic Interstitial Pneumonias: A Pathological StudyRespiration, 2009
- Increased Allergic Rhinitis Rates Among U.S. Military Personnel After Deployment To The Persian GulfJournal of Allergy and Clinical Immunology, 2008
- Bronchiolitis: The Pathologist's PerspectiveProceedings of the American Thoracic Society, 2006
- Interpretative strategies for lung function testsEuropean Respiratory Journal, 2005
- Respiratory health status of Australian veterans of the 1991 Gulf War and the effects of exposure to oil fire smoke and dust stormsThorax, 2004
- Collagen Vascular Disease???Related Lung DiseaseJournal of Computer Assisted Tomography, 2004
- Self-reported illness and health status among Gulf War veterans. A population-based study. The Iowa Persian Gulf Study GroupPublished by American Medical Association (AMA) ,1997
- Bronchiolitis Obliterans from Exposure to Incinerator Fly AshJournal of Occupational and Environmental Medicine, 1995