Respiratory Disorder Seen in Iraq, Afghanistan Veterans

Study Shows Some Service Members Return From the Middle East With Constrictive Bronchiolitis

Medically Reviewed by Laura J. Martin, MD on July 22, 2011

July 22, 2011 -- Breathing problems in some soldiers returning from duty in Iraq and Afghanistan may be signs of a respiratory disorder rarely seen in healthy young adults, a study shows.

The research suggests that exposure to unknown toxins in the Middle East may be behind unexplained breathing problems in otherwise healthy veterans.

Researchers found evidence of constrictive bronchiolitis in 38 of 49 soldiers who reported shortness of breath during exercise.

Constrictive bronchiolitis is a respiratory disorder in which the small airways in the lungs become compressed and narrowed by scar tissue or inflammation. The condition is non-reversible and there are few effective treatments available.

Reports of breathing problems in soldiers returning from the Middle East have been common since the 1990s. But researchers say respiratory conditions such as pneumonia, asthma, and allergic rhinitis do not completely explain the increase in respiratory symptoms, such as shortness of breath and exercise limitations.

Respiratory Disorder in Returning Vets

In this study, published in the New England Journal of Medicine, researchers evaluated 80 soldiers from Fort Campbell, Ky., who reported difficulty in breathing during exercise.

"The soldiers were unable to achieve the fitness standard for the 2-mile run that all had met before deployment," write researcher Matthew S. King, MD, of Meharry Medical College in Nashville, Tenn., and colleagues. "Many of the soldiers reported having been exposed to smoke from a fire in a large sulfur mine near Mosul, Iraq, during the summer of 2003, but several of the soldiers reported having no specific exposure."

All of the soldiers underwent physical and lung examinations as well as high-resolution computed tomography (CT) scans. Among these, 49 had lung biopsies after these tests didn't explain their symptoms.

The results showed all of the lung biopsies were abnormal; 38 of 49 biopsies showed signs of constrictive bronchiolitis. Other respiratory conditions that could explain the soldiers' breathing problems were found in the remaining 11 cases.

Researchers say all of the soldiers with constrictive bronchiolitis had normal chest X-rays, but about a quarter had nodules on their lungs revealed by CT scans.

They say the results suggest that this otherwise rare respiratory disorder may be common in soldiers returning from duty in the Middle East who report breathing problems that aren't explained by standard tests.