Constrictive bronchiolitis should be considered for soldiers with history of inhalational exposure
WEDNESDAY, July 20 (HealthDay News) -- Constrictive bronchiolitis should be considered as a reason for unexplained exertional dyspnea among previously healthy soldiers with a history of inhalational exposure, according to a study published in the July 21 issue of the New England Journal of Medicine.
Matthew S. King, M.D., from the Vanderbilt University School of Medicine in Nashville, Tenn., and colleagues investigated the existence of exertional dyspnea among 80 previously healthy U.S. soldiers with a history of inhalational exposure during service in Iraq and Afghanistan. The soldiers' medical and exposure history was evaluated, along with their physical examinations and results from pulmonary-function testing and high-resolution computed tomography. Thoracoscopic lung biopsy was performed on 49 of the soldiers to identify a cause for their symptoms. Cardiopulmonary-exercise and pulmonary-function testing results were compared with results from historical military control subjects.
The investigators found a common but not universal history of inhalational exposure to a 2003 sulfur-mine fire in Iraq. All 49 thoracoscopic lung biopsies were abnormal, of which 38 were indicative of a diagnosis of constrictive bronchiolitis. Other diagnoses for dyspnea were established for the remaining 11 soldiers. All 38 soldiers with constrictive bronchiolitis showed normal chest radiography results, although one-quarter of them exhibited mosaic air trapping or centrilobular nodules. The pulmonary-function and cardiopulmonary-exercise testing results were poor compared to military controls but still within normal population limits.
"Evaluation for constrictive bronchiolitis should be considered among returning veterans who report having exercise limitations and who have essentially normal results on imaging and physiological studies," the authors write.
One author disclosed a financial relationships with Actelion Pharmaceuticals.