Head trauma and loss of limbs garner the most attention when the medical impact of the U.S. military involvement in the Middle East is discussed, but life in the desert also has had a severe impact on the respiratory systems of many soldiers.
The effects of combat and life in the desert were examined May 18 in symposium D6 “Occupational Lung Diseases in U.S. Military Personnel Deployed to Iraq and Afghanistan.”
It should come as no surprise that desert dust storms caused respiratory problems, but the burning of waste, a massive sulfur fire and even percussive effects of bombs and artillery took a toll on men and women who were in excellent physical condition, and the problems continued even as military personnel returned home.
Presenting an overview of the problems encountered by veterans of the conflicts in the Middle East, as well as research about the increase in lung problems, was Anthony M. Szema, M.D., assistant professor of medicine and surgery at Stony Brook School of Medicine and chief of the allergy section at Veterans Affairs Medical Center in Northport, N.Y.
Dr. Szema presented a study of the new onset of asthma in soldiers serving in Iraq, which compared records of soldiers who were based in Iraq for more than one year with records of soldiers based in the U.S. Soldiers deployed in Iraq had an asthma rate of 6.6 percent, versus 4.3 percent for solders in the U.S.
The increased risk for asthma was seen in two age groups, 26-30 and 36-40, he said. In addition, spirometric measurements showed that FEV1/FVC ratios of soldiers who served in Iraq were lower than that of both non-smoking and smoking men from three main ethnic groups — Caucasians, African-Americans and Mexican-Americans.
Dr. Szema concluded by saying, “Deployment to Iraq is associated with an increased likelihood of being diagnosed with asthma.”
Factors affecting pulmonary health in the Middle East included blast overpressure, indoor aeroallergens, burn pits, dust storms and outdoor aeroallergens, such as date palm pollen, he said.
Another study examined the effect of irradiated soil from Camp Victory in Iraq on lung tissue in mice compared with the same test using rutile dust from Georgia. The soil from Iraq caused inflammation of the tissue after just one shot, while the dust from Georgia did not cause problems, Dr. Szema said.
Another study focused on the case of a soldier working in a laundry in Iraq who began experiencing pulmonary problems, which were probably linked to the desert environment and exposure to many explosions in combat zones, Dr. Szema said. A section of the patient’s lung was analyzed using micro X-ray fluorescence, which detected titanium, iron and copper in discrete regions.
Robert Miller, MD, associate professor of medicine, allergy, pulmonary and critical care at Vanderbilt University in Nashville, reported on similar problems in a presentation on constrictive bronchiolitis following service in Iraq and Afghanistan.
A series of studies following the 1991 Gulf War all found significant increases in respiratory illness in soldiers after serving in the war, Dr. Miller said. These studies, along with his treatment of soldiers at Fort Campbell, which is near Vanderbilt, led Dr. Miller to examine whether there is a relationship between service in the Middle East and the development of respiratory disease. Among the questions raised were whether respiratory problems presented after returning home and if they were difficult to detect.
Many of the soldiers at Fort Campbell had been stationed in Iraq near the Al Mishraq sulfur mine fire in 2003. The fire resulted in the largest sulfur dioxide release in history, and it contaminated waters in the area.
“In 2004, we started seeing patients (from Fort Campbell) who were typically athletic, non-smokers,” Dr. Miller said, adding that even more soldiers were examined after returning from multiple deployments in the Middle East, where they were exposed to burn pits, dust storms and battlefield smoke. “They were unable to complete a 2-mile run. They consistently could not meet this military standard when they came to us.”
The soldiers had normal, or near normal, pulmonary function tests, high resolution computed tomography (HRCT) tests and cardiopulmonary exercise testing, he said. Of 80 soldiers referred, 49 eventually underwent a VATS lung biopsy, and 38 were found to have constrictive bronchiolitis. Although sulfur dioxide is known to cause constrictive bronchiolitis, 25 percent of the 38 soldiers had not been near the 2003 sulfur fire.
The question that baffled physicians was why conventional studies failed to detect the presence of constrictive bronchiolitis in the soldiers, Dr. Miller said.
“Pulmonary testing was mildly abnormal, but it did not give a hint. Nothing we looked at was suggestive of pathologic lesions in the lung,” he said, adding the patients presented with constrictive bronchiolitis post-deployment.