Palliative care screening, sleep devices, novel biologics

Occupational and environmental health

Post-deployment lung disease

Since the early 1990s, ongoing military deployments to Southwest Asia remain a unique challenge from a pulmonary symptomology and diagnostic perspective.

Various airborne hazards in the deployment environment include geologic dusts, burn pit smoke, vehicle emissions, and industrial air pollution. Exposures can give rise to both acute respiratory symptoms and, in some instances, chronic lung disease. Currently, data are limited on whether inhalation of airborne particulate matter by military personnel is linked to increases in pulmonary diseases (Morris MJ, et al. US Army Med Dep J. 2016:173).

Ongoing research by the Veterans Affairs continues to enroll post-deployed personnel in an Airborne Hazard and Burn Pit Registry. Past approaches in evaluation of deployed individuals ranged from common tests such as spirometry, HRCT scanning, full PFTs, bronchoprovocation challenges, and, in some instances, lung biopsies (Krefft SD, et al. Fed Pract. 2015;32[6]:32). More novel evaluations of postdeployment dyspnea include impulse oscillometry, exhaled nitric oxide, bronchoscopy, and cardiopulmonary exercise testing (Huprikar, et al. Chest. 2016;150[4]:S934A).

Members of the CHEST Occupational and Environmental Health NetWork are currently updating comprehensive approaches to evaluate military personnel with chronic respiratory symptoms from deployments. Continued emphasis, however, should be placed on diagnosing and treating common diseases such as asthma, exercise-induced bronchospasm, GERD, and upper airway disorders.

Pedro F. Lucero, MD, FCCP

Steering Committee Member