Consensus Statements on Deployment-Related Respiratory Disease, Inclusive of Constrictive Bronchiolitis

Falvo, Michael J.; Sotolongo, Anays; Osterholzer, John J.; Robertson, Michelle W; Kazerooni, Ella A.; Amorosa, Judith K.; Garshick, Eric; Jones, Kirk D.; Galvin, Jeffrey R.; Kreiss, Kathleen; Hines, Stella E.; Franks, Teri J.; Miller, Robert F.; Rose, Cecile S.; Arjomandi, Mehrdad; Krefft, S.D.; Morris, Michael J.; Polosukhin, Vasiliy V.; Blanc, Paul D.; DʼArmiento, Jeanine

doi:10.1016/j.chest.2022.10.031

Cited by 12 publications

(11 citation statements)

References 28 publications

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“…Computerized analysis of chest CT scans may offer additional diagnostic information, supplementing visual interpretation [66 ▪▪ ]. As emphasized by a recent consensus statement, lung biopsy considerations (e.g., to diagnose constrictive bronchiolitis) should be informed by multidisciplinary review as well as by specific expertise in pulmonary pathology [67 ▪▪ ]. As there is no specific treatment for constrictive bronchiolitis postdeployment, performing a biopsy after a nondiagnostic evaluation may not alter clinical decision making.…”

Section: Clinical Assessmentmentioning

confidence: 99%

Military deployment-related respiratory problems: an update

Garshick

Blanc

2023

Current Opinion in Pulmonary Medicine

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Purpose of reviewMilitary personnel deployed to Southwest Asia and Afghanistan were potentially exposed to high levels of fine particulate matter and other pollutants from multiple sources, including dust storms, burn pit emissions from open-air waste burning, local ambient air pollution, and a range of military service-related activities that can generate airborne exposures. These exposures, individually or in combination, can have adverse respiratory health effects. We review exposures and potential health impacts, providing a framework for evaluation.Recent findingsParticulate matter exposures during deployment exceeded U.S. National Ambient Air Quality Standards. Epidemiologic studies and case series suggest that in postdeployment Veterans with respiratory symptoms, asthma is the most commonly diagnosed illness. Small airway abnormalities, most notably particularly constrictive bronchiolitis, have been reported in a small number of deployers, but many are left without an established diagnosis for their respiratory symptoms. The Promise to Address Comprehensive Toxics Act was enacted to provide care for conditions presumed to be related to deployment exposures. Rigorous study of long-term postdeployment health has been limited.SummaryVeterans postdeployment to Southwest Asia and Afghanistan with respiratory symptoms should undergo an exposure assessment and comprehensive medical evaluation. If required, more advanced diagnostic considerations should be utilized in a setting that can provide multidisciplinary expertise and long-term follow-up.

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Section: Clinical Assessmentmentioning

confidence: 99%

Military deployment-related respiratory problems: an update

Garshick

Blanc

2023

Current Opinion in Pulmonary Medicine

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“…noninvasive techniques are unavailable and further diagnostic clarity is needed or if symptoms worsen and lung function declines, a lung biopsy may be warranted. 6 Results may inform treatment strategies. 46 What Treatment Options Are Helpful?…”

Section: Deployment-related Respiratory Disease Krefft Zell-baranmentioning

confidence: 99%

“…6 Future recommendations will depend on results from larger observational and prospective trials. 6 There may be utility in periodic monitoring of symptoms and lung function to identify those subjects at risk of progressive respiratory disease.…”

Section: Deployment-related Respiratory Disease Krefft Zell-baranmentioning

confidence: 99%

“…Fewer veterans have required lung biopsy due to increased knowledge of the case definitions of DDLD and frank discussion of risks and benefits of invasive testing. 6 When Table 2 Recommended diagnostic evaluation for deployment-related respiratory diseases (DRRDs)…”

Section: When Could a Lung Biopsy Be Helpful?mentioning

confidence: 99%

“…This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.noninvasive techniques are unavailable and further diagnostic clarity is needed or if symptoms worsen and lung function declines, a lung biopsy may be warranted 6. Results may inform treatment strategies 46.…”

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confidence: 99%

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Deployment-Related Respiratory Disease: Where Are We?

Krefft

Zell-Baran

2023

Semin Respir Crit Care Med

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Military personnel and veterans who have deployed to Afghanistan, Iraq, and parts of Southwest Asia (SWA) since 1990 are at risk of developing a host of respiratory symptoms and deployment-related respiratory diseases (DRRDs). This review aims to summarize our current understanding of DRRD and inform pulmonary practitioners of recent updates to DRRD screening, diagnosis, evaluation, and management. The most common respiratory diseases in these patients include asthma, chronic sinonasal disease, laryngeal disease/dysfunction, and distal lung disease. Pulmonary function testing and chest imaging are the most commonly used diagnostic tools, but techniques such as lung clearance index testing via multiple breath washout, forced oscillation testing/impulse oscillometry, and quantitative chest computed tomography (CT) assessment appear promising as noninvasive modalities to aid in lung disease detection in this population. 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.

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