Evaluating Deployment-related Respiratory Diseases in Military Veterans

Abstract

Deployed military personnel often develop respiratory symptoms and disorders due to exposure to particulate matter such as dust, blast materials, and burn pit emissions. A range of deployment-related respiratory diseases have been reported, including toxic lung injury, eosinophilic pneumonia, asthma, chronic obstructive pulmonary disease, bronchiolitis, and interstitial lung disease. The Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics Act of 222, which was enacted in 2022, expanded coverage of medical care for veterans and improved awareness of deployment-related respiratory diseases. This law added 23 diagnoses presumed to be connected to deployment but has failed to address issues related to the diagnosis of deployment-related respiratory disorders. Diagnosing some of the respiratory disorders associated with deployment can be challenging, as symptoms are often nonspecific. Veterans who present with respiratory symptoms should undergo a comprehensive assessment, including a detailed medical and exposure history, pulmonary function tests, imaging, and serologic screening for autoimmune disorders. A decision on whether a surgical lung biopsy should be performed should be made on a case-by-case basis on the basis of multidisciplinary review and an informed discussion with the patient. The clinical care team should discuss pharmacological and nonpharmacological treatment options with the patient and direct them to reliable sources of information. Long-term follow-up is essential to monitor for worsening of pulmonary function or symptoms. Further research is needed to characterize associations between deployment-related exposures and respiratory health outcomes and to inform better means of assessment and treatment of military veterans.

Keywords: military personnel; occupational exposure; progressive pulmonary fibrosis; respiratory; signs and symptoms.

Figure 1.

Most frequent symptoms reported by patients in the Airborne Hazards and Open Burn Pit Registry (AHOBPR) (25).

Figure 2.

Evaluating deployed veterans with shortness of breath. COPD = chronic obstructive pulmonary disease; CPET = cardiopulmonary exercise testing; Dl_CO = diffusion capacity of the lung for carbon monoxide; DRRD = deployment-related respiratory disease; HRCT = high-resolution computed tomography; ILD = interstitial lung disease; PA-Lat = posteroanterior and lateral; PFT = pulmonary function test.