Post-deployment lung ills stirring winds of debate
Written on June 18, 2011 by Jordan Ballard
As a teenager in northern New York, Gary Durham ran cross-country and hiked the Adirondacks’ high peaks. In Army basic training, he did two-mile runs in less than 13 minutes. But after a yearlong deployment to Iraq with the 101st Airborne Division in 2003, he says he started gasping for air while mowing the lawn.
An emerging body of research indicates Durham is one of a significant number of U.S. service members reporting respiratory problems like coughing, wheezing or chest pains that started during deployment and continued after they returned home.
In 2009, a major survey of military personnel, the Millennium Cohort Study, found that 14 percent of troops who had deployed reported new breathing problems, compared with 10 percent among those who had not deployed.
Though the percentage difference seems small, when extrapolated over the 2 million troops who have deployed since 2001, the survey suggested that at least 80,000 additional service members had developed post-deployment breathing problems.
But now, a fierce debate is under way over how long-lasting and severe those problems really are.
On one side are scientists, many working for the government, who say a large number of returning troops have serious and potentially lifelong ailments. They point to an array of respiratory hazards in Iraq and Afghanistan including powerful dust storms, fine dust laced with toxins and “burn pits” used to incinerate garbage at military bases as potential culprits.
Those scientists also question whether the government has acted swiftly enough to study the effects of prolonged exposure to dust, allergens and pollution in Iraq and Afghanistan, and whether it is properly compensating those who may have service-connected lung injuries.
“I’m concerned that this exposure is not getting the serious review it needs,” said Capt. Mark Lyles, the chairman of medical sciences and biotechnology at the Center for Naval Warfare Studies in Newport, R.I., who has studied dust from Iraq and Afghanistan.
On the other side of the debate are officials with the Pentagon and the Department of Veterans Affairs who assert that research remains inconclusive. They acknowledge that some troops are returning with respiratory symptoms but say those problems vary widely depending on genetic background or location of deployment and are usually temporary.
“I think we are going to find that there is some increase in respiratory symptoms, and maybe even respiratory diagnoses,” said Col. Lisa Zacher, a doctor who is pulmonary consultant to the Army’s surgeon general. “But I think we’ll find the majority who deploy do not have long-term chronic pulmonary diseases related to deployment.”
Durham’s breathing struggles have proved to be long term.
When he returned in 2004, Durham was coughing up phlegm daily. Yet a battery of lung tests showed nothing wrong. Before he was medically discharged as a sergeant in 2005, an Army doctor suggested his problem might be psychological, records show.
Then last year, Durham read about a specialist who had treated Iraq veterans for breathing problems. The doctor did a lung biopsy on Durham and concluded he had a debilitating and largely untreatable injury known as constrictive bronchiolitis.
Durham felt vindicated.
“I had been told there was nothing wrong with me by so many doctors,” he said. “I just wanted to know what was wrong with me.”
Dr. Robert Miller, who treated Durham at Vanderbilt University Medical Center, has conducted biopsies on 56 previously deployed veterans, many from Fort Campbell, Ky.
He found that 40 of them had constrictive bronchiolitis, an irreversible scarring of the small airways that can make breathing during moderate exercise feel like “sucking air through a straw,” Miller said. Fifteen other biopsies led to diagnoses of other lung ailments.
Almost all Miller’s patients had been through standard lung-function tests like CT scans and spirometry that found nothing wrong. Constrictive bronchiolitis is typically found in people with lung transplants or rheumatoid arthritis, or who work with industrial chemicals, but is rare in the general population.
“My concern is that these guys come back from war, can’t do a two-mile run and then are dismissed from the Army,” Miller said. “They are told: ‘Maybe you’re out of condition.’ “
Respiratory problems among returning troops have been the subject of Senate hearings and Pentagon studies that have focused heavily on the burn pits found at scores of bases across Iraq and Afghanistan. But a growing number of experts say the problem is probably more complex than those fires.
Lyles, whose latest research was described recently by USA Today, argues that air particles found in Iraq and Afghanistan are exceptionally fine and thus more readily inhaled into the lungs.
Those particles carry an array of harmful metals, bacteria and fungi that are different from and potentially more toxic than dust in the United States, Lyles and his fellow researchers say.
Another scientist affiliated with the government, Anthony Szema, was an author last year of a paper that found that previously deployed troops were more likely to report new cases of asthma than troops who had not deployed.
Zacher and other military officials have raised sharp questions about the research by Miller, Szema and Lyles.
Those officials say many of Miller’s patients were exposed to acidic smoke from a sulfur-mine fire near Mosul in 2003 that may have injured their lungs, suggesting that those injuries are unique to a relatively small group of soldiers. Miller, however, said some of his patients were deployed after 2003.
In a statement, the Navy said Lyles’ work lacked “scientific rigor” and that its own studies had found “no increase in the incidence of diseases to which Dr. Lyles inferred a cause and effect link from exposure to Middle East sand.”
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