Purpose of review: Military personnel and civilian contractors who have deployed to Iraq, Afghanistan, and other south-west Asia locations since 2001 may be at risk for a spectrum of disorders collectively known as deployment-related respiratory diseases. Diagnosis is often challenging as typical symptoms of cough, dyspnea, and decreased exercise tolerance may be accompanied by subtle abnormalities on noninvasive diagnostic testing despite significant histopathologic abnormalities identified on lung biopsy. This review describes the emerging spectrum of deployment-related respiratory diseases, addresses diagnostic challenges, and updates recommendations for evaluation and management.
Recent findings: Investigators from Vanderbilt University, Nashville, TN, found constrictive bronchiolitis on 38 surgical lung biopsies in a case series of army deployers with unexplained chest symptoms. More recently, in a group of 50 consecutive deployed patients evaluated at San Antonio Military Medical Center, 36% were found to have airway hyperreactivity, whereas 42% were undiagnosed.
Summary: We propose a diagnostic and management algorithm for evaluation of the patient with postdeployment respiratory symptoms who are at risk of deployment-related lung disease.
aDepartment of Environmental and Occupational Health, Anschutz Medical Center, University of Colorado
bColorado School of Public Health, Aurora
cDivision of Rheumatology
dDivision of Environmental and Occupational Health Sciences, National Jewish Health, Denver
eDivision of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Denver, Colorado, USA
Correspondence to Cecile S. Rose, MD, MPH, National Jewish Health, 1400 Jackson Street, G206, Denver, CO 80206, USA. Tel: +1 303 398 1867; fax: +1 303 398 1452; e-mail: RoseC@NJHealth.org