Pedro Lucero

Study of Active Duty Military for Pulmonary Disease Related to Environmental Deployment Exposures (STAMPEDE)

RATIONALE Because of increased levels of airborne particulate matter in Southwest Asia, deployed military personnel are at risk for developing acute and chronic lung diseases. Increased respiratory symptoms are reported, but limited data exist on reported lung diseases. OBJECTIVES To evaluate new respiratory complaints in military personnel returning from Southwest Asia to determine potential etiologies for symptoms. METHODS Returning military personnel underwent a prospective standardized evaluation for deployment-related respiratory symptoms within 6 months of returning to their duty station. MEASUREMENTS AND MAIN RESULTS Prospective standardized evaluation included full pulmonary function testing, high-resolution chest tomography, methacholine challenge testing, and fiberoptic bronchoscopy with bronchoalveolar lavage. Other procedures including lung biopsy were performed if clinically indicated. Fifty patients completed the study procedures. A large percentage (42%) remained undiagnosed, including 12% with normal testing and an isolated increase in lavage neutrophils or lymphocytes. Twenty (40%) patients demonstrated some evidence of airway hyperreactivity to include eight who met asthma criteria and two with findings secondary to gastroesophageal reflux. Four (8%) additional patients had isolated reduced diffusing capacity and the remaining six had other miscellaneous airway disorders. No patients were identified with diffuse parenchymal disease on the basis of computed tomography imaging. A significant number (66%) of this cohort had underlying mental health and sleep disorders. CONCLUSIONS Evaluation of new respiratory symptoms in military personnel after service in Southwest Asia should focus on airway hyperreactivity from exposures to higher levels of ambient particulate matter. These patients may be difficult to diagnose and require close follow-up.

Granulomatous lung masses in an elderly patient with inactive Crohn's disease

This is a case report of a 77-year-old female with Crohns disease manifested by recurrent bowel obstructions, who required surgical resections on two occasions but no further medical treatment. She presented 2 years later with pulmonary infiltrates, hilar adenopathy, and multiple lung masses. Biopsies of the masses demonstrated noncaseating granulomatous inflammation and fibrosis similar to the pathology from her bowel resection. Six months later, these pulmonary lesions partially resolved without therapy. This case illustrates significant pulmonary manifestations of Crohns disease in the absence of active gastrointestinal disease.

Prevalence of Supranormal Pulmonary Function Test Values Between a Military and Nonmilitary Cohort

BACKGROUND: The study objective was to determine differences in the proportion of supranormal pulmonary function tests (PFTs) between active duty (AD) military personnel and a similar non-active duty (non-AD) population. Given the emphasis on cardiovascular fitness in the military, it has been hypothesized that regular exercise in this cohort leads to an increased proportion of supranormal PFTs. We hypothesized that a comparison of PFTs would identify no differences in the ratio of supranormal to normal PFTs between the AD and non-AD populations. METHODS: A retrospective chart review was conducted of all PFT studies at the Brooke Army Medical Center from 2006 to 2011. Studies were included with either an FVC or FEV1 > 110% of predicted, with both values > 100% of predicted. A comparative analysis was performed for patients between 18 and 50 years of age based on AD status. Further analysis was performed on all ages to determine the distribution of supranormal findings in the entire study population. RESULTS: A total of 16,600 interpreted PFTs were queried. Of those, 4,303 (31.6%) were AD patients, and 9,306 (68.4%) were non-AD patients. From all of the PFTs reviewed, a total of 912 (6.7%) were identified as supranormal. When further analyzed, 381 (9.4%) of AD patients 18–50 years old were supranormal, 175 (12.4%) of non-AD patients 18–50 years old were supranormal, and 356 (4.7%) of non-AD patients older than 50 years were supranormal. CONCLUSIONS: This study revealed no significant difference in the proportion of supranormal-to-normal PFTs in an AD versus non-AD duty population of the same age range. Based on these findings, no assumption should be made that supranormal PFTs are more common in military personnel. Interpretation of normal PFTs in AD personnel undergoing evaluation should not differ from that in any typical patient.

Increased Airway Hyperreactivity with the M40 Protective Mask in Exercise-Induced Bronchospasm

Objective. Exercise-induced bronchospasm (EIB) has a prevalence of 6% to 7% in United States Army personnel and 3% to 13% in professional athletes. There are reported concerns that military personnel with EIB will have increased airway hyperreactivity or significant dyspnea while wearing the standard military M40 protective mask. The objective of this study is to determine whether the M40 protective gas mask increases airway hyperreactivity in military personnel with exertional dyspnea and the diagnosis of EIB. Methods. Ten active duty military with EIB (defined as history of exertional dyspnea, normal spirometry, and reactive methacholine challenge test) and 10 normal control subjects were evaluated. Both the participants and control subjects underwent baseline exercise challenge testing (ECT) with and without the M40 protective mask. Forced expiratory volume in one second (FEV1) (percent predicted) post ECT was compared to baseline FEV1 within and between groups along with exercise time. Results. There was no statistical difference in between individuals and between groups wearing the M40 mask. None of the study group had a positive ECT exercising without the M40 mask while 20% of the study group with EIB had a positive ECT wearing the M40 mask. Conclusion. Military personnel with EIB who exercised with the M40 protective mask did not overall have significantly increased airway hyperreactivity compared to control subjects. Screening ECT may be beneficial in identifying those susceptible persons who report symptoms while wearing the M40 protective mask.