Rare lung disease diagnosed in soldiers
Jimmy Williams didn’t realize his military service might be the reason for his breathing problems when he retired from the U.S. Army in 2007 after two tours in Iraq.
He thought he was simply out of shape. “I was really tired all the time, wore out,” he said. “I was just feeling run down, gasping for air. I could hardly mow my yard.”
Williams now knows he suffers from constrictive bronchiolitis, a rare condition that cannot be diagnosed with X-rays or pulmonary function tests. A team of Tennessee researchers discovered scarring inside the small airways of his lungs and those of other soldiers who served in Iraq and Afghanistan.
Their findings, published today in The New England Journal of Medicine, could help veterans prove disabilities stemming from their war service.
“These guys had very believable stories,” said Dr. Robert F. Miller of Vanderbilt University Medical Center. “In a large majority of cases, they were elite athletes at the time of deployment. Now, they can’t run two miles.”
Although many of the soldiers were exposed to a 2003 sulfur-mine fire near Mosul, Iraq, not all were, so the exact cause of the lung damage remains a mystery. Another big question is how many undiagnosed veterans are suffering from the ailment.
Although Williams had brief exposure to the mine fire, he believes a burn pit at Balad, Iraq, to dispose of garbage, debris and military equipment caused his condition.
“I would wake up at night choking,” he said. “I had black soot on everything I owned, but we didn’t think about it. We just did our jobs.”
Miller first noticed the illness in 2004 when perplexed doctors at Blanchfield Army Community Hospital in Fort Campbell referred some soldiers to Vanderbilt. He and colleague Dr. Matthew S. King, who is now at Meharry Medical College, started looking for the cause along with other lung specialists.
It took surgery — open lung biopsies — for the physicians to make the diagnoses.
“I think the whole situation was kind of surprising because this constrictive bronchiolitis is a very uncommon disease in people who are otherwise healthy,” said King, the lead author of the study. “It is common in people who have had lung or bone marrow transplants. It is common in people who have lupus. It is common in people who have autoimmune disease. But it is not at all common in fit, young military personnel or other healthy people.”
The disorder, however, can result from inhaling irritants. Workers in factories where diacetyl is used to make microwavable popcorn have been diagnosed with the condition.
The study was conducted from February 2004 through December 2009.
It began with 80 soldiers. Forty-nine of them agreed to undergo the open lung biopsies. Of that number, 38 were diagnosed with constrictive bronchiolitis. Twenty-eight of those soldiers had been exposed to the sulfur-mine fire.
Other exposures included dust storms, burn pits and combat smoke.
“I don’t think our study links this disorder to burn pits,” Miller said. “Burn pits may be a problem that contributes to this disorder. I think what we can say is that this disorder is linked to service in the Middle East. We haven’t been able to definitively link what the cause is for this.”
The patients who have been treated have not shown improvement, King said, but their conditions have not worsened since they have been stateside.
Vanderbilt is shipping 45 slides to National Jewish Hospital in Denver, where a researcher has received a U.S. Department of Defense grant to try to determine what substances are lodged in the tissues of the lung samples.
Miller is urging the U.S. Department of Veterans Affairs to recognize this disorder in making decisions about disability.
Williams went to a VA center to apply for disability assistance, but the representative told him the request probably would be denied because of the lack of medical data about the condition.
“It’s not just me,” he said. “It’s the other soldiers out there that have the same problem but are afraid to come forward. … They are fathers with families. What do they have for the future to look for?”
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