Document Detail


Constrictive bronchiolitis in soldiers returning from Iraq and Afghanistan.
MedLine Citation:
PMID:  21774710     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
Authors:
Matthew S King; Rosana Eisenberg; John H Newman; James J Tolle; Frank E Harrell; Hui Nian; Mathew Ninan; Eric S Lambright; James R Sheller; Joyce E Johnson; Robert F Miller
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The New England journal of medicine     Volume:  365     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-07-21     Completed Date:  2011-07-28     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  222-30     Citation Subset:  AIM; IM    
Affiliation:
Division of Pulmonary and Critical Care Medicine, Meharry Medical College, Nashville, TN, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Afghan Campaign 2001-
Bronchioles / pathology*
Bronchiolitis Obliterans / pathology,  physiopathology*,  radiography
Exercise Test
Exercise Tolerance*
Follow-Up Studies
Humans
Iraq War, 2003 - 2011
Lung / pathology,  radiography
Military Personnel*
Prevalence
Respiratory Function Tests
Tomography, X-Ray Computed
United States
Grant Support
ID/Acronym/Agency:
KL2 RR024977/RR/NCRR NIH HHS; KL2 TR000446/TR/NCATS NIH HHS; TL1 RR024978/RR/NCRR NIH HHS; TL1 TR000447/TR/NCATS NIH HHS; UL1 RR024975/RR/NCRR NIH HHS; UL1 RR024975-05/RR/NCRR NIH HHS; UL1 TR000445/TR/NCATS NIH HHS; UL1-RR024975/RR/NCRR NIH HHS
Comments/Corrections
Comment In:
N Engl J Med. 2011 Nov 3;365(18):1743-4; author reply 1744-5   [PMID:  22047575 ]
N Engl J Med. 2011 Nov 3;365(18):1743; author reply 1744-5   [PMID:  22047574 ]
N Engl J Med. 2011 Nov 3;365(18):1744; author reply 1744-5   [PMID:  22047576 ]
Erratum In:
N Engl J Med. 2011 Nov 3;365(18):1749

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