Our Returning Soldiers and Constrictive Bronchiolitis.

Too many of our returning soldiers have it – the Agent Orange of 2010 – lung disease leading to the good, the bad and the ugly.

The only thing “good” about the following is that it is bringing public attention to an invisible disease and the 4th leading cause of death in the nation, killing 120,000 people a year. COPD is expected to be the 3rd leading cause of death by 2020.

The “bad” is our soldiers were hit by the invisible permanent lung damage of constrictive bronchiolitis.

“…In 2008, Miller and pulmonary/critical care fellow, Matthew King, M.D., pulled together the first round of what they believe is solid evidence that soldiers are returning with serious and permanent lung injuries related to their service….”

“…The soldiers also shared similar stories of exposure in Iraq to massive amounts of smoke from sulfur fires in 2003, or breathing air fouled by sand and smoke from burn pits all over the country. Miller made a… “unconventional” move and recommended surgical biopsies.

“So far, all but a few of these soldiers we have biopsied have had constrictive bronchiolitis,” Miller said…”

The ‘ugly’ is that our soldiers and nation are faced with 2010’s version of ‘Agent Orange.

“… typical example of what may be an emerging profile: a soldier who was fit, a lifelong non-smoker, and who returned from deployment in Iraq with permanent lung damage.

Since 2004, physicians serving the Fort Campbell Army base have been referring dozens of soldiers with exercise-induced shortness of breath to Vanderbilt, to see Robert Miller, M.D., associate professor of Allergy, Pulmonary and Critical Care Medicine. “

“The soldiers also shared similar stories of exposure in Iraq to massive amounts of smoke from sulfur fires in 2003, or breathing air fouled by sand and smoke from burn pits all over the country.

Miller began to wonder if conventional testing might not be enough. He made what he calls an “unconventional” move and recommended surgical biopsies.

“So far, all but a few of these soldiers we have biopsied have had constrictive bronchiolitis,” Miller said.

Constrictive bronchiolitis, also called Bronchiolitis Obliterans, is a narrowing of the tiniest and deepest airways of the lungs.

It is rare, and can only be diagnosed through biopsy. Cases that have been documented in the medical literature show striking similarities to what is seen in the soldier’s biopsies.

“These are inhalation injuries, suffered in the line of duty,” said Miller.

In 2008, Miller and pulmonary/critical care fellow, Matthew King, M.D., pulled together the first round of what they believe is solid evidence that soldiers are returning with serious and permanent lung injuries related to their service.

Most of the first patients biopsied were 101st Airborne soldiers who fought the Mishraq Sulfur Mine fires in 2003. Later, many soldiers reported exposure to burn pits, especially a massive, 10-acre burn pit in Balad, Iraq….”

Deployment in Mosul renders a former marathon runner and mom of 7-year-old daughters “unable to pass her military physical fitness testing.”

“The former marathon runner and mother of 7-year-old twin daughters returned from deployment in Mosul in 2007 unable to pass her military physical fitness testing. Even her colleagues at the Army hospital couldn’t help her pinpoint what was wrong.

When Waters heard about Miller’s work she came to Vanderbilt in 2008. Her biopsy confirmed constrictive bronchiolitis.

“As a medical officer, I am considered fit for duty because I can still work in the O.R., even if it is only one day per week,” Waters said. “But my future is uncertain. Once I leave the service it could be very difficult to get medical coverage because of my preexisting medical condition.”

Miller says he is concerned soldiers continue to be tested for shortness of breath across the country using only conventional methods.

He says surgical biopsy and definitive diagnosis are required just to create the possibility of proper compensation, but even then, there is no guarantee.
“Even with positive biopsy, disability ratings have been highly variable,” Miller said.”

http://www.mc.vanderbilt.edu/reporter/index.html?ID=8270

Thanks to the bright, thinking and unconventional medical folks approach at Vanderbilt and elsewhere, Chronic Obstructive Pulmonary Disease (COPD) is beginning to see the light of day.

More later… Sharon O’Hara