1
|
Wang X, Doherty TA, James C. Military burn pit exposure and airway disease: Implications for our Veteran population. Ann Allergy Asthma Immunol 2023; 131:720-725. [PMID: 37343826 PMCID: PMC10728339 DOI: 10.1016/j.anai.2023.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/23/2023]
Abstract
Millions of veterans have been exposed to burn pit smoke during combat deployments throughout the last three decades. Toxic compounds present in burn pit fumes that may cause or exacerbate upper and lower airway diseases include dioxins, polyaromatic hydrocarbons, and particulate matter, among others. There have been several observational studies evaluating the potential role of burn pit exposure in the development of a multitude chronic health conditions, and the veterans Administration has established the Airborne Hazards and Open Burn Pit Registry in 2014. However, specific causality of airway disease from burn pits has been difficult to prove, and there are multiple barriers toward etiologic research. Preclinical models have demonstrated airway dysfunction and inflammation but modeling human exposures remains challenging. Here, we review the current literature on the potential impact of burn pit exposure on chronic airway disease.
Collapse
Affiliation(s)
- Xinyu Wang
- Section of Allergy and Immunology, Department of Medicine, University of California San Diego, La Jolla, California; Veterans Affairs San Diego Health Care System, La Jolla, California
| | - Taylor A Doherty
- Section of Allergy and Immunology, Department of Medicine, University of California San Diego, La Jolla, California; Veterans Affairs San Diego Health Care System, La Jolla, California.
| | - Christine James
- Section of Allergy and Immunology, Department of Medicine, University of California San Diego, La Jolla, California; Veterans Affairs San Diego Health Care System, La Jolla, California
| |
Collapse
|
2
|
Olsen T, Caruana D, Cheslack-Postava K, Szema A, Thieme J, Kiss A, Singh M, Smith G, McClain S, Glotch T, Esposito M, Promisloff R, Ng D, He X, Egeblad M, Kew R, Szema A. Iraq/Afghanistan war lung injury reflects burn pits exposure. Sci Rep 2022; 12:14671. [PMID: 36038588 PMCID: PMC9424528 DOI: 10.1038/s41598-022-18252-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 08/08/2022] [Indexed: 12/25/2022] Open
Abstract
This descriptive case series retrospectively reviewed medical records from thirty-one previously healthy, war-fighting veterans who self-reported exposure to airborne hazards while serving in Iraq and Afghanistan between 2003 and the present. They all noted new-onset dyspnea, which began during deployment or as a military contractor. Twenty-one subjects underwent non-invasive pulmonary diagnostic testing, including maximum expiratory pressure (MEP) and impulse oscillometry (IOS). In addition, five soldiers received a lung biopsy; tissue results were compared to a previously published sample from a soldier in our Iraq Afghanistan War Lung Injury database and others in our database with similar exposures, including burn pits. We also reviewed civilian control samples (5) from the Stony Brook University database. Military personnel were referred to our International Center of Excellence in Deployment Health and Medical Geosciences, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell under the auspices of Northwell IRB: 17-0140-FIMR Feinstein Institution for Medical Research "Clinicopathologic characteristics of Iraq Afghanistan War Lung Injury." We retrospectively examined medical records, including exposure data, radiologic imaging, and non-invasive pulmonary function testing (MGC Diagnostic Platinum Elite Plethysmograph) using the American Thoracic Society (ATS) standard interpretation based on Morgan et al., and for a limited cohort, biopsy data. Lung tissue, when available, was examined for carbonaceous particles, polycyclic aromatic hydrocarbons (Raman spectroscopy), metals, titanium connected to iron (Brookhaven National Laboratory, National Synchrotron Light Source II, Beamline 5-ID), oxidized metals, combustion temperature, inflammatory cell accumulation and fibrosis, neutrophil extracellular traps, Sirius red, Prussian Blue, as well as polarizable crystals/particulate matter/dust. Among twenty-one previously healthy, deployable soldiers with non-invasive pulmonary diagnostic tests, post-deployment, all had severely decreased MEP values, averaging 42% predicted. These same patients concurrently demonstrated abnormal airways reactance (X5Hz) and peripheral/distal airways resistance (D5-D20%) via IOS, averaging - 1369% and 23% predicted, respectively. These tests support the concept of airways hyperresponsiveness and distal airways narrowing, respectively. Among the five soldiers biopsied, all had constrictive bronchiolitis. We detected the presence of polycyclic aromatic hydrocarbons (PAH)-which are products of incomplete combustion-in the lung tissue of all five warfighters. All also had detectable titanium and iron in the lungs. Metals were all oxidized, supporting the concept of inhaling burned metals. Combustion temperature was consistent with that of burned petrol rather than higher temperatures noted with cigarettes. All were nonsmokers. Neutrophil extracellular traps were reported in two biopsies. Compared to our prior biopsies in our Middle East deployment database, these histopathologic results are similar, since all database biopsies have constrictive bronchiolitis, one has lung fibrosis with titanium bound to iron in fixed mathematical ratios of 1:7 and demonstrated polarizable crystals. These results, particularly constrictive bronchiolitis and polarizable crystals, support the prior data of King et al. (N. Engl. J. Med. 365:222-230, 2011) Soldiers in this cohort deployed to Iraq and Afghanistan since 2003, with exposure to airborne hazards, including sandstorms, burn pits, and improvised explosive devices, are at high risk for developing chronic clinical respiratory problems, including: (1) reduction in respiratory muscle strength; (2) airways hyperresponsiveness; and (3) distal airway narrowing, which may be associated with histopathologic evidence of lung damage, reflecting inhalation of burned particles from burn pits along with particulate matter/dust. Non-invasive pulmonary diagnostic tests are a predictor of burn pit-induced lung injury.
Collapse
Affiliation(s)
- Timothy Olsen
- grid.16416.340000 0004 1936 9174University of Rochester School of Medicine and Dentistry, Simon Business School, University of Rochester, Rochester, USA
| | - Dennis Caruana
- grid.47100.320000000419368710Yale University School of Medicine, New Haven, USA
| | - Keely Cheslack-Postava
- grid.21729.3f0000000419368729Columbia University Global Psychiatric Epidemiology Group, NYSPI Columbia University Department of Psychiatry, New York, USA
| | - Austin Szema
- grid.261112.70000 0001 2173 3359Northeastern University College of Art, Media, and Design (CAMD) Game Design Program, Boston, USA ,grid.202665.50000 0001 2188 4229Brookhaven National Laboratory National Synchrotron Light Source II Beam ID-5, Upton, USA
| | - Juergen Thieme
- grid.202665.50000 0001 2188 4229Brookhaven National Laboratory National Synchrotron Light Source II Beam ID-5, Upton, USA
| | - Andrew Kiss
- grid.36425.360000 0001 2216 9681Science Coordinator Imaging and Microscopy Program and Department of Geosciences, Stony Brook University, Stony Brook, USA
| | - Malvika Singh
- grid.202665.50000 0001 2188 4229Brookhaven National Laboratory National Synchrotron Radiation Light Source II Bean ID-5, Upton, USA
| | - Gregory Smith
- grid.36425.360000 0001 2216 9681Department of Pharmacological Sciences, Stony Brook University, Stony Brook, USA
| | | | - Timothy Glotch
- grid.36425.360000 0001 2216 9681Center for Space Exploration (CEx) Department of Geosciences, Stony Brook University, Stony Brook, USA
| | - Michael Esposito
- grid.512756.20000 0004 0370 4759Department of Pathology North Shore University Hospital Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
| | - Robert Promisloff
- grid.166341.70000 0001 2181 3113Drexel University College of Medicine, Philadelphia, USA
| | - David Ng
- grid.134907.80000 0001 2166 1519Rockefeller University Department of Cancer Biology, New York, USA
| | - Xueyan He
- grid.225279.90000 0004 0387 3667Cold Spring Harbor Laboratory Department of Cancer Biology, Cold Spring Harbor, New York, USA
| | - Mikala Egeblad
- grid.225279.90000 0004 0387 3667Cold Spring Harbor Laboratory Department of Cancer Biology, Cold Spring Harbor, New York, USA
| | - Richard Kew
- grid.36425.360000 0001 2216 9681Department of Pathology Stony Brook University, Stony Brook, NY USA
| | - Anthony Szema
- grid.416477.70000 0001 2168 3646Division of Pulmonary and Critical Care, Division of Allergy/Immunology, Northwell Health, New Hyde Park, USA ,grid.512756.20000 0004 0370 4759Department of Occupational Medicine, Epidemiology and Prevention, International Center of Excellence in Deployment Health and Medical Geosciences, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
| |
Collapse
|
3
|
Hill CJ, Meyer CD, McLean JE, Anderson DC, Hao Y, Lin FC, Kimple AJ, Capra GG. Burn Pit Exposure Is Associated With Increased Sinonasal Disease. J Occup Environ Med 2022; 64:629-634. [PMID: 35673272 PMCID: PMC9357047 DOI: 10.1097/jom.0000000000002551] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether self-reported burn pit exposure is associated with increased subjective and objective sinus disease. DESIGN A cross-sectional study was performed evaluating consecutive adult patients presenting to a US Military rhinology clinic. Demographics, medical histories, sinonasal quality-of-life scores, and nasal endoscopy examinations were obtained. Participants were divided into three cohorts based on self-reported exposure histories and outcomes compared. RESULTS One hundred eighty-six patients met the inclusion criteria, the majority of whom were male. Patients with burn pit exposure had worse Sinonasal Outcome Test-22 scores (49.9) compared with those deployed without burn pit exposure (31.8) or never deployed (31.5). Endoscopic findings demonstrated worse disease within those exposed (Lund-Kennedy score, 3.3) compared with the other cohorts (1.8 and 1.7, respectively). CONCLUSIONS These novel findings suggest that deployment-related burn pit exposure is associated with increased subjective and objective sinus disease.
Collapse
Affiliation(s)
- Christopher J. Hill
- Department of Otolaryngology - Head & Neck Surgery, Naval Medical Center Portsmouth, VA
| | - Charles D. Meyer
- Department of Otolaryngology - Head & Neck Surgery, Naval Medical Center Portsmouth, VA
| | - James E. McLean
- Department of Otolaryngology - Head & Neck Surgery, Naval Medical Center Portsmouth, VA
| | - Danielle C. Anderson
- Department of Otolaryngology - Head & Neck Surgery, Naval Medical Center Portsmouth, VA
| | - Yajing Hao
- Department of Biostatistics, Gillings School of Global Public Health
| | - Feng-Chang Lin
- Department of Biostatistics, Gillings School of Global Public Health
| | - Adam J. Kimple
- Department of Otolaryngology - Head & Neck Surgery, University of North Carolina Chapel Hill
| | - Gregory G. Capra
- Department of Otolaryngology - Head & Neck Surgery, Naval Medical Center Portsmouth, VA
| |
Collapse
|
4
|
Berman R, Kopf KW, Min E, Huang J, Downey GP, Alam R, Chu HW, Day BJ. IL-33/ST2 signaling modulates Afghanistan particulate matter induced airway hyperresponsiveness in mice. Toxicol Appl Pharmacol 2020; 404:115186. [PMID: 32777237 DOI: 10.1016/j.taap.2020.115186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 12/17/2022]
Abstract
Increased symptoms of asthma-like respiratory illnesses have been reported in soldiers returning from tours of duty in Afghanistan. Inhalation of desert particulate matter (PM) may contribute to this deployment-related lung disease (DRLD), but little is known about disease mechanisms. The IL-33 signaling pathway, including its receptor ST2, has been implicated in the pathogenesis of lung diseases including asthma, but its role in PM-mediated airway dysfunction has not been studied. The goal of this study was to investigate whether IL-33/ST2 signaling contributes to airway dysfunction in preclinical models of lung exposure to Afghanistan PM (APM). Wild-type (WT) and ST2 knockout (KO) mice on the BALB/C background were oropharyngeally instilled with a single dose of saline or 50 μg of APM in saline. Airway hyperresponsiveness (AHR) and inflammation were assessed after 24 h. In WT mice, a single APM exposure induced AHR and neutrophilic inflammation. Unlike the WT mice, ST2 KO mice that lack the receptor for IL-33 did not demonstrate AHR although airway neutrophilic inflammation was comparable to the WT mice. Oropharyngeal delivery of a soluble ST2 decoy receptor in APM-exposed WT mice significantly blocked AHR. Additional data in mouse tracheal epithelial cell and lung macrophage cultures demonstrated a role of APM-induced IL-33/ST2 signaling in suppression of regulator of G protein signaling 2 (RGS2), a gene known to protect against bronchoconstriction. We present for the first time that APM may increase AHR, one of the features of asthma, in part through the IL-33/ST2/RGS2 pathway.
Collapse
Affiliation(s)
- Reena Berman
- Department of Medicine, Basic Science Section, National Jewish Health, Denver, CO, United States of America
| | - Katrina W Kopf
- Biological Resource Center, National Jewish Health, Denver, CO, United States of America
| | - Elysia Min
- Department of Medicine, Medicine Office of Research, National Jewish Health, Denver, CO, United States of America
| | - Jie Huang
- Department of Medicine, Medicine Office of Research, National Jewish Health, Denver, CO, United States of America
| | - Gregory P Downey
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, National Jewish Health, Denver, CO, United States of America
| | - Rafeul Alam
- Department of Medicine, Division of Allergy & Clinical Immunology, National Jewish Health, Denver, CO, United States of America
| | - Hong Wei Chu
- Department of Medicine, Basic Science Section, National Jewish Health, Denver, CO, United States of America.
| | - Brian J Day
- Department of Medicine, Medicine Office of Research, National Jewish Health, Denver, CO, United States of America.
| |
Collapse
|