User login
Screening for Respiratory Diseases in Post-9/11 Veterans
TOPLINE:
Military veterans exposed to burn pits during deployment are > 4 times higher risk for persistent cough and 3 times higher risk for dyspnea and wheezing compared with unexposed veterans. Following clinical evaluation, nearly half of veterans received diagnoses of respiratory diseases, including asthma (about 30%), chronic obstructive pulmonary disease (about 13%), and bronchitis (about 12%). Diagnostic uncertainty remains common, with nearly one-third of symptomatic veterans still lacking a specific diagnosis after extensive noninvasive testing.
METHODOLOGY:
- Focused review that proposed an assessment and monitoring strategy for deployed US military veterans with unexplained dyspnea that incorporates multidisciplinary review and patient discussion.
- Analysis included data from the Study of Active Duty Military for Pulmonary Disease Related to Environmental Deployment Exposures (STAMPEDE), which evaluated respiratory symptoms in military personnel within 6 months of returning from Southwest Asia.
- Registry and survey input included Airborne Hazards and Open Burn Pit Registry clinical evaluations in 24,578 veterans in addition to a survey of 479 veterans.
- Biopsy guidance emphasized case-by-case decisions after review; supporting examples include 49 symptomatic veterans undergoing high-resolution computed tomography in STAMPEDE and 38 veterans with biopsy-proven constrictive bronchiolitis, many with normal or near normal pulmonary function tests (PFTs).
TAKEAWAY:
- Veterans with persistent unexplained cough, dyspnea, or chest tightness for > 3 months, reduced exercise tolerance, or abnormal PFTs should be referred to a pulmonary specialist for diagnostic evaluation.
- Among 380 military personnel with chronic respiratory symptoms in STAMPEDE III, 22.9% had diagnoses of asthma, 15.0% had airway hyperreactivity, 10.8% had upper and large airways disorders, and 32.0% did not meet criteria for a specific diagnosis after extensive noninvasive testing.
- Standard testing can miss disease: among 38 veterans with biopsy-proven constrictive bronchiolitis, 19 had normal or near normal PFTs compared with the general population, despite reductions vs a historical asymptomatic military cohort.
- Long-term management centers on follow-up, with proposed PFT monitoring every 6 to 12 months in symptomatic patients even when initial findings are normal.
IN PRACTICE:
“Significant gaps remain in the provision of health care and benefits,” the authors wrote. “The assessment of veterans with suspected lung disease should be comprehensive, involving a thorough medical and exposure history, as well as PFTs and imaging.
SOURCE:
The study was led by Robert M. Tighe, MD, Duke University Medical Center in Durham, North Carolina; Le Roy Torres, Burn Pits 360 in Robstown, Texas; and Robert Miller, Vanderbilt University Medical Center in Nashville, Tennessee. It was published online in Annals of the American Thoracic Society.
LIMITATIONS:
This article synthesizes existing literature and expert recommendations without presenting new primary data or statistical analyses. The review acknowledges that diagnosing deployment-related respiratory disorders can be challenging as symptoms are often nonspecific and may present months or years after deployment with variable latency. The current Post-Deployment Cardiopulmonary Evaluation Network structure does not have the capacity to evaluate the large number of veterans with respiratory disorders and is limited to those who have registered symptoms through the Airborne Hazards and Open Burn Pit Registry.
DISCLOSURES:
Writing support was provided by Julie Fleming and Wendy Morris of Fleishman-Hillard, which was contracted and funded by Boehringer Ingelheim Pharmaceuticals. Boehringer Ingelheim was given the opportunity to review the article for medical and scientific accuracy as well as intellectual property considerations. No disclosures or conflict of interest statements for the individual authors are provided in the study.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
TOPLINE:
Military veterans exposed to burn pits during deployment are > 4 times higher risk for persistent cough and 3 times higher risk for dyspnea and wheezing compared with unexposed veterans. Following clinical evaluation, nearly half of veterans received diagnoses of respiratory diseases, including asthma (about 30%), chronic obstructive pulmonary disease (about 13%), and bronchitis (about 12%). Diagnostic uncertainty remains common, with nearly one-third of symptomatic veterans still lacking a specific diagnosis after extensive noninvasive testing.
METHODOLOGY:
- Focused review that proposed an assessment and monitoring strategy for deployed US military veterans with unexplained dyspnea that incorporates multidisciplinary review and patient discussion.
- Analysis included data from the Study of Active Duty Military for Pulmonary Disease Related to Environmental Deployment Exposures (STAMPEDE), which evaluated respiratory symptoms in military personnel within 6 months of returning from Southwest Asia.
- Registry and survey input included Airborne Hazards and Open Burn Pit Registry clinical evaluations in 24,578 veterans in addition to a survey of 479 veterans.
- Biopsy guidance emphasized case-by-case decisions after review; supporting examples include 49 symptomatic veterans undergoing high-resolution computed tomography in STAMPEDE and 38 veterans with biopsy-proven constrictive bronchiolitis, many with normal or near normal pulmonary function tests (PFTs).
TAKEAWAY:
- Veterans with persistent unexplained cough, dyspnea, or chest tightness for > 3 months, reduced exercise tolerance, or abnormal PFTs should be referred to a pulmonary specialist for diagnostic evaluation.
- Among 380 military personnel with chronic respiratory symptoms in STAMPEDE III, 22.9% had diagnoses of asthma, 15.0% had airway hyperreactivity, 10.8% had upper and large airways disorders, and 32.0% did not meet criteria for a specific diagnosis after extensive noninvasive testing.
- Standard testing can miss disease: among 38 veterans with biopsy-proven constrictive bronchiolitis, 19 had normal or near normal PFTs compared with the general population, despite reductions vs a historical asymptomatic military cohort.
- Long-term management centers on follow-up, with proposed PFT monitoring every 6 to 12 months in symptomatic patients even when initial findings are normal.
IN PRACTICE:
“Significant gaps remain in the provision of health care and benefits,” the authors wrote. “The assessment of veterans with suspected lung disease should be comprehensive, involving a thorough medical and exposure history, as well as PFTs and imaging.
SOURCE:
The study was led by Robert M. Tighe, MD, Duke University Medical Center in Durham, North Carolina; Le Roy Torres, Burn Pits 360 in Robstown, Texas; and Robert Miller, Vanderbilt University Medical Center in Nashville, Tennessee. It was published online in Annals of the American Thoracic Society.
LIMITATIONS:
This article synthesizes existing literature and expert recommendations without presenting new primary data or statistical analyses. The review acknowledges that diagnosing deployment-related respiratory disorders can be challenging as symptoms are often nonspecific and may present months or years after deployment with variable latency. The current Post-Deployment Cardiopulmonary Evaluation Network structure does not have the capacity to evaluate the large number of veterans with respiratory disorders and is limited to those who have registered symptoms through the Airborne Hazards and Open Burn Pit Registry.
DISCLOSURES:
Writing support was provided by Julie Fleming and Wendy Morris of Fleishman-Hillard, which was contracted and funded by Boehringer Ingelheim Pharmaceuticals. Boehringer Ingelheim was given the opportunity to review the article for medical and scientific accuracy as well as intellectual property considerations. No disclosures or conflict of interest statements for the individual authors are provided in the study.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
TOPLINE:
Military veterans exposed to burn pits during deployment are > 4 times higher risk for persistent cough and 3 times higher risk for dyspnea and wheezing compared with unexposed veterans. Following clinical evaluation, nearly half of veterans received diagnoses of respiratory diseases, including asthma (about 30%), chronic obstructive pulmonary disease (about 13%), and bronchitis (about 12%). Diagnostic uncertainty remains common, with nearly one-third of symptomatic veterans still lacking a specific diagnosis after extensive noninvasive testing.
METHODOLOGY:
- Focused review that proposed an assessment and monitoring strategy for deployed US military veterans with unexplained dyspnea that incorporates multidisciplinary review and patient discussion.
- Analysis included data from the Study of Active Duty Military for Pulmonary Disease Related to Environmental Deployment Exposures (STAMPEDE), which evaluated respiratory symptoms in military personnel within 6 months of returning from Southwest Asia.
- Registry and survey input included Airborne Hazards and Open Burn Pit Registry clinical evaluations in 24,578 veterans in addition to a survey of 479 veterans.
- Biopsy guidance emphasized case-by-case decisions after review; supporting examples include 49 symptomatic veterans undergoing high-resolution computed tomography in STAMPEDE and 38 veterans with biopsy-proven constrictive bronchiolitis, many with normal or near normal pulmonary function tests (PFTs).
TAKEAWAY:
- Veterans with persistent unexplained cough, dyspnea, or chest tightness for > 3 months, reduced exercise tolerance, or abnormal PFTs should be referred to a pulmonary specialist for diagnostic evaluation.
- Among 380 military personnel with chronic respiratory symptoms in STAMPEDE III, 22.9% had diagnoses of asthma, 15.0% had airway hyperreactivity, 10.8% had upper and large airways disorders, and 32.0% did not meet criteria for a specific diagnosis after extensive noninvasive testing.
- Standard testing can miss disease: among 38 veterans with biopsy-proven constrictive bronchiolitis, 19 had normal or near normal PFTs compared with the general population, despite reductions vs a historical asymptomatic military cohort.
- Long-term management centers on follow-up, with proposed PFT monitoring every 6 to 12 months in symptomatic patients even when initial findings are normal.
IN PRACTICE:
“Significant gaps remain in the provision of health care and benefits,” the authors wrote. “The assessment of veterans with suspected lung disease should be comprehensive, involving a thorough medical and exposure history, as well as PFTs and imaging.
SOURCE:
The study was led by Robert M. Tighe, MD, Duke University Medical Center in Durham, North Carolina; Le Roy Torres, Burn Pits 360 in Robstown, Texas; and Robert Miller, Vanderbilt University Medical Center in Nashville, Tennessee. It was published online in Annals of the American Thoracic Society.
LIMITATIONS:
This article synthesizes existing literature and expert recommendations without presenting new primary data or statistical analyses. The review acknowledges that diagnosing deployment-related respiratory disorders can be challenging as symptoms are often nonspecific and may present months or years after deployment with variable latency. The current Post-Deployment Cardiopulmonary Evaluation Network structure does not have the capacity to evaluate the large number of veterans with respiratory disorders and is limited to those who have registered symptoms through the Airborne Hazards and Open Burn Pit Registry.
DISCLOSURES:
Writing support was provided by Julie Fleming and Wendy Morris of Fleishman-Hillard, which was contracted and funded by Boehringer Ingelheim Pharmaceuticals. Boehringer Ingelheim was given the opportunity to review the article for medical and scientific accuracy as well as intellectual property considerations. No disclosures or conflict of interest statements for the individual authors are provided in the study.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Screening for Respiratory Diseases in Post-9/11 Veterans
Screening for Respiratory Diseases in Post-9/11 Veterans