New Recommendations

Clinicians who treat servicemembers who have been or will be deployed to Iraq and Afghanistan should consider adopting some components of the pre- and post-deployment medical surveillance procedures presented by Coleen Baird, MD, MPH, the Army’s program manager for Environmental Medicine, according to symposium presenters.

Developed in a meeting on airborne hazards potential related to deployment, the recommendations are to conduct a standardized questionnaire that includes demographic information, current respiratory symptoms, previous lung disease and smoking history, and job duties. Individuals also should have spirometry and an exercise capacity evaluation including one and 3-mile run times.

Findings that should prompt a diagnostic referral, according to Meehan and Baird, include unexplained cough, shortness of breath or wheezing for more than three months, an abnormal spirometry pattern or a post-deployment decline in function as measured by spirometry of 15% or more even in the absence of other symptoms or decline of 10% if other symptoms are present. In addition, a significant decline in physical readiness test (PRT) results should generate a referral for evaluation.

Baird recommended that diagnostic testing include a comprehensive medical questionnaire combined with a physical examination that focuses on the cardiopulmonary system and body mass index. In addition, full PRTs should be conducted along with a methacholine challenge and maximum exercise tolerance testing with arterial blood gases. She advocated high-resolution CT scans in prone and supine positions with inspiratory and expiratory views and referral for a lung biopsy to assess constrictive bronchiolitis in individual cases.

While evidence is mounting that multiple factors contribute to the high rate of respiratory and other illnesses among those who served in Iraq and Afghanistan, burn pits definitely are not off the hook. The IoM found that none of the individual chemical products of the combustion produced by the burn pits “appear to have been present at concentrations likely to be responsible for the adverse health outcomes studied,” but “the overall effect of the mixture [of those chemicals] may be to increase the likelihood or severity of the outcome.”

Szema is conducting a study of veterans whose health issues may be attributed to burn pits or other environmental exposure in Iraq and Afghanistan. Interested veterans and physicians can learn more and enroll in a registry designed to facilitate research at www.burnpits360.org. The registry will track symptoms, diagnoses, location and dates of assignment, and demographic data.

BurnPits 360

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