1
|
Hayden L, Lightner JM, Strausborger S, Franks TJ, Watson NL, Lewin-Smith MR. Particle analysis of surgical lung biopsies from deployed and non-deployed US service members during the Global War on Terrorism. PLoS One 2024; 19:e0301868. [PMID: 38603724 PMCID: PMC11008878 DOI: 10.1371/journal.pone.0301868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 03/22/2024] [Indexed: 04/13/2024] Open
Abstract
The role that inhaled particulate matter plays in the development of post-deployment lung disease among US service members deployed to Southwest Asia during the Global War on Terrorism has been difficult to define. There is a persistent gap in data addressing the relationship between relatively short-term (months to a few years) exposures to high levels of particulate matter during deployment and the subsequent development of adverse pulmonary outcomes. Surgical lung biopsies from deployed service members and veterans (DSMs) and non-deployed service members and veterans (NDSMs) who develop lung diseases can be analyzed to potentially identify residual deployment-specific particles and develop associations with pulmonary pathological diagnoses. We examined 52 surgical lung biopsies from 25 DSMs and 27 NDSMs using field emission scanning electron microscopy (FE-SEM) with energy dispersive x-ray spectroscopy (EDS) to identify any between-group differences in the number and composition of retained inorganic particles, then compared the particle analysis results with the original histopathologic diagnoses. We recorded a higher number of total particles in biopsies from DSMs than from NDSMs, and this difference was mainly accounted for by geologic clays (illite, kaolinite), feldspars, quartz/silica, and titanium-rich silicate mixtures. Biopsies from DSMs deployed to other Southwest Asia regions (SWA-Other) had higher particle counts than those from DSMs primarily deployed to Iraq or Afghanistan, due mainly to illite. Distinct deployment-specific particles were not identified. Particles did not qualitatively associate with country of deployment. The individual diagnoses of the DSMs and NDSMs were not associated with elevated levels of total particles, metals, cerium oxide, or titanium dioxide particles. These results support the examination of particle-related lung disease in DSMs in the context of comparison groups, such as NDSMs, to assist in determining the strength of associations between specific pulmonary pathology diagnoses and deployment-specific inorganic particulate matter exposure.
Collapse
Affiliation(s)
- Leslie Hayden
- Institute for Functional Materials and Devices, Lehigh University, Bethlehem, Pennsylvania, United States of America
| | - James M. Lightner
- Environmental Microscopy Laboratory, Joint Pathology Center, Silver Spring, Maryland, United States of America
| | - Stacy Strausborger
- Environmental Microscopy Laboratory, Joint Pathology Center, Silver Spring, Maryland, United States of America
| | - Teri J. Franks
- Pulmonary and Mediastinal Pathology, Joint Pathology Center, Silver Spring, Maryland, United States of America
| | - Nora L. Watson
- Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
| | - Michael R. Lewin-Smith
- Environmental Pathology, Joint Pathology Center, Silver Spring, Maryland, United States of America
| |
Collapse
|
2
|
Davis CW, Rabin AS, Jani N, Osterholzer JJ, Krefft S, Hines SE, Arjomandi M, Robertson MW, Sotolongo AM, Falvo MJ. Postdeployment Respiratory Health: The Roles of the Airborne Hazards and Open Burn Pit Registry and the Post-Deployment Cardiopulmonary Evaluation Network. Fed Pract 2022; 39:337-343. [PMID: 36425809 PMCID: PMC9652027 DOI: 10.12788/fp.0307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background Following deployment to the Southwest Asia theater of operations and Afghanistan, many service members and veterans report respiratory symptoms and concerns about their military and environmental exposures. The US Department of Veterans Affairs (VA) established the national Airborne Hazards and Open Burn Pit Registry (AHOBPR) in 2014 to help better understand long-term health conditions that may be related to these exposures. Observations The AHOBPR provides an online questionnaire and optional health evaluation performed by a primary care or environmental health clinician. The clinical evaluation provides an opportunity for the service member or veteran to talk with a health care professional about their symptoms, exposures, and potential treatment. Data derived from questionnaire responses and health evaluations facilitate medical surveillance and research. The VA also established a network of specialists, referred to as the Post-Deployment Cardiopulmonary Evaluation Network (PDCEN). The PDCEN identifies veterans within the AHOBPR who self-report certain conditions or have unexplained dyspnea and conducts comprehensive diagnostic evaluations. Primary objectives of PDCEN evaluations are to define respiratory and related conditions that are present, determine whether conditions are related to deployment, and work with the veteran's clinician to identify treatments and/or follow-up care to improve their health. We utilize a case example to illustrate the role of the primary care practitioner in connecting veterans to PDCEN clinical evaluations. Conclusions AHOBPR clinical evaluations represent an initial step to better understand postdeployment health conditions. The PDCEN clinical evaluation extends the AHOBPR evaluation by providing specialty care for certain veterans requiring more comprehensive evaluation while systematically collecting and analyzing clinical data to advance the field.
Collapse
Affiliation(s)
- Caroline W Davis
- Veterans Affairs Ann Arbor Health Care System, LTC Charles S. Kettles Veterans Affaris Medical Center, Michigan
- University of Michigan, Ann Arbor
| | - Alexander S Rabin
- Veterans Affairs Ann Arbor Health Care System, LTC Charles S. Kettles Veterans Affaris Medical Center, Michigan
- University of Michigan, Ann Arbor
| | - Nisha Jani
- Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange
| | - John J Osterholzer
- Veterans Affairs Ann Arbor Health Care System, LTC Charles S. Kettles Veterans Affaris Medical Center, Michigan
- University of Michigan, Ann Arbor
| | - Silpa Krefft
- Veterans Affairs Eastern Colorado Health Care System, Aurora
- National Jewish Health, Division of Environmental and Occupational Health Sciences, Denver, Colorado
- University of Colorado, School of Medicine, Aurora
| | - Stella E Hines
- Veterans Affairs Maryland Health Care System, Baltimore Veterans Affairs Medical Center
- Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Mehrdad Arjomandi
- San Francisco Veterans Affairs Medical Center, California
- Division of Pulmonary, Critical Care, Allergy and Immunology, and Sleep Medicine, Department of Medicine, University of California, San Francisco
- Division of Occupational and Environmental Medicine; Department of Medicine, University of California, San Francisco
| | - Michelle W Robertson
- Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange
| | - Anays M Sotolongo
- Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange
- Rutgers New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark
| | - Michael J Falvo
- Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange
- Rutgers New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark
| |
Collapse
|
3
|
Affiliation(s)
- Alexander S Rabin
- From the Division of Pulmonary and Critical Care, Department of Medicine, Veterans Affairs Ann Arbor Healthcare System, and the Division of Pulmonary and Critical Care, Department of Medicine, University of Michigan - both in Ann Arbor (A.S.R., C.W.D., J.J.O.); and the Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, East Orange (A.M.S., M.J.F.), and the Division of Pulmonary and Critical Care, Department of Medicine (A.M.S.), and the Departments of Pharmacology, Physiology and Neuroscience, and Physical Medicine and Rehabilitation (M.J.F.), Rutgers New Jersey Medical School, Newark
| | - Caroline W Davis
- From the Division of Pulmonary and Critical Care, Department of Medicine, Veterans Affairs Ann Arbor Healthcare System, and the Division of Pulmonary and Critical Care, Department of Medicine, University of Michigan - both in Ann Arbor (A.S.R., C.W.D., J.J.O.); and the Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, East Orange (A.M.S., M.J.F.), and the Division of Pulmonary and Critical Care, Department of Medicine (A.M.S.), and the Departments of Pharmacology, Physiology and Neuroscience, and Physical Medicine and Rehabilitation (M.J.F.), Rutgers New Jersey Medical School, Newark
| | - Anays M Sotolongo
- From the Division of Pulmonary and Critical Care, Department of Medicine, Veterans Affairs Ann Arbor Healthcare System, and the Division of Pulmonary and Critical Care, Department of Medicine, University of Michigan - both in Ann Arbor (A.S.R., C.W.D., J.J.O.); and the Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, East Orange (A.M.S., M.J.F.), and the Division of Pulmonary and Critical Care, Department of Medicine (A.M.S.), and the Departments of Pharmacology, Physiology and Neuroscience, and Physical Medicine and Rehabilitation (M.J.F.), Rutgers New Jersey Medical School, Newark
| | - Michael J Falvo
- From the Division of Pulmonary and Critical Care, Department of Medicine, Veterans Affairs Ann Arbor Healthcare System, and the Division of Pulmonary and Critical Care, Department of Medicine, University of Michigan - both in Ann Arbor (A.S.R., C.W.D., J.J.O.); and the Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, East Orange (A.M.S., M.J.F.), and the Division of Pulmonary and Critical Care, Department of Medicine (A.M.S.), and the Departments of Pharmacology, Physiology and Neuroscience, and Physical Medicine and Rehabilitation (M.J.F.), Rutgers New Jersey Medical School, Newark
| | - John J Osterholzer
- From the Division of Pulmonary and Critical Care, Department of Medicine, Veterans Affairs Ann Arbor Healthcare System, and the Division of Pulmonary and Critical Care, Department of Medicine, University of Michigan - both in Ann Arbor (A.S.R., C.W.D., J.J.O.); and the Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, East Orange (A.M.S., M.J.F.), and the Division of Pulmonary and Critical Care, Department of Medicine (A.M.S.), and the Departments of Pharmacology, Physiology and Neuroscience, and Physical Medicine and Rehabilitation (M.J.F.), Rutgers New Jersey Medical School, Newark
| |
Collapse
|