New insight into pulmonary health threat to U.S. troops stationed overseas

Lung tissue analysis has shown [in detail] some serious threats to the health of military service members. The U.S. Geological Survey partnered with a researcher at National Jewish Health to look into airborne threats in various locations where service members work and live. It revealed some unpleasant surprises. To find out more, Federal News Network’s Eric White spoke to National Jewish Health pulmonologist, Dr. Cecile Rose on the Federal Drive with Tom Temin.

Interview Transcript:  

Dr. Cecile Rose For the study that you were interested in. We took a leave 24 the biopsies from the 64 of previously deployed military people with lung disease, and we compared them to 11 lung tissue samples of people who were deceased and whose tissue was available to us in a tissue biobank. You know, for example, this is people who may have been involved in a motor vehicle crash and they donated their lung tissue for science. And so that was archived for our use. So we took 24 of the previous deployed biopsies and the 11 from the controls, the deceased controls, to see if there was any difference between the particle matter that was contained in the lungs, the inorganic dust, we call it, contained in the lungs of the previously deployed military personnel compared with controls. And we were fortunate because we had, information on their ages, their smoking histories, their gender, those kinds of things that may also impact retained lung dust. So we had a really important opportunity to compare differences between people who had previously deployed to those who had not.

Eric White And you, I imagine, found some major differences.

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Dr. Cecile Rose We did working with scientists from the U.S. Geological Survey who have access to very, very sophisticated, equipment and analytical techniques. We were able to look at these lung tissues and compare these two cohorts, the previously deployed to the controls. And what we found was that the people who had previously deployed had substantially and significantly higher proportions of silica dust and silicate dust in their lungs compared to the controls. And what was even more compelling about that is that the previously deployed cases, for whom we had lung tissue samples were younger, so they had had less time to accumulate dust in their lungs than the controls. And they were also, percentage wise, less likely to have smoked. That just happened to be the statistics for the control samples were, you know, the percentage was higher for smokers in the controls than the deployer. So again, you would expect that maybe that would make it more likely that our findings would be non-significant. You know that the deployers may have had more dust, but they were younger, the less likely to smoke, and maybe it would all be a wash. So we were surprised at how significant the differences were in terms of the proportions of silica dust in the lung. Tissue samples from the, the pores compared of the controls.

Eric White Yeah. Is the over simple takeaway from this study that this is more of a chronic respiratory disease, is more of a prevalent problem with those who have been deployed more recently than, than, you know, just the people who were stationed next to a burn pit or something like that.

Dr. Cecile Rose If I understand your question, I would tell you that I think, you know, what our findings show is that if people have previously deployed to areas like Iraq and Afghanistan, their proportions of retained lung dust containing silica and silicates is significantly higher. And, you know, in terms of there being a clear ability for us to relate that to burn pits or diesel exhaust or combat dust or some of the things that I mentioned at the beginning, it’s hard for us to do that. I think there is a suggestion, however, that people who go to these very arid, very dusty environments, are much more likely to retain silica dust in their lungs than if they hadn’t gone to those deployment areas.

Eric White Got it. And so, you know, they’re deploying to these places. They’re not it’s not the moon. You know, how is it that folks are able to live out in these areas, even though they’re very remote and very dusty, and you introduce new people to the environment and all of a sudden their lungs are infected. Is it just the old trope of, you know, don’t drink the local water unless you’re used to it kind of thing?

Dr. Cecile Rose Yeah. You know, that’s a really important question. And it comes up a lot. And that is if this exposure is important to our military men and women and places them at risk, what about the people who live there all the time? And the answer there is, we don’t know. Simply put. I would guess that those people probably are at risk for lung disease from exposure to particulate matter in the same way that our military men and women are. But they may have other, more acute and serious challenges than chronic lung disease, from having lived in those areas where, you know, really access to, you know, social services and infrastructure may not be nearly what we’re used to. I would guess there is probably a lot of lung disease within those populations, but they have not been studied. And it really would be inferential, not based on any any true scientific evidence that I have understood.

Eric White Okay. And so there’s probably no real good answer to this, but is there anything that can be done other than limiting exposure, you know, are there any tools in place that might be able to be utilized to try and put a stop to the amount, or at least just lessen the blow, of the chronic respiratory diseases that veterans are coming home with.

Dr. Cecile Rose Well, we have certainly given that a lot of thought, and I would tell you that I think there probably are some administrative techniques that could be used to minimize exposures, especially during things like dust storms. But that said, I am by no means, you know, a person who knows how to tell the military how to limit exposures, especially when you know people are in, you know, deployed to areas of combat where there are many, many risks. But that said, I think it’s important that people who return with respiratory symptoms are taken seriously, that they are not dismissed if they have a simple breathing test that’s normal, or a chest x ray that doesn’t show much. This requires a different level of diagnostic intensity and evaluation. So that’s the first thing. The second thing is, I think that it is important for us to understand what the relevant exposures are. And there were some limitations to our study. So, you know, because we are looking at lung tissue, we can’t say very much about other kinds of exposures that people may have had, for example, to paint fumes or to allergens or to other organic chemicals or pesticides, because we can’t measure those in the lung tissue samples. We just, you know, that the technology does not allow us to do that. And so we can say that there were high levels of silica in the lung tissue samples, but we can’t say that that’s the only problem. So that’s that’s really an important point, I think for me to make is I would suspect that there probably are other relevant exposures that were just not measurable using the techniques, the analytical tools and equipment that we had. But I think that the military realizes and and that the VA also realizes that that people are returning with. Victory injury and that they need to be monitored over time to make sure that we are taking good care of them, to see whether they, these folks, develop any unexpected or long latency diseases. Those are diseases, respiratory diseases that may take time to show up. And it’s also important, I think, for military people and doctors to to realize that there is this 2022 Pact act. And the Pact act is a congressionally mandated act that understands or presumes that if people have certain respiratory disease diagnoses, that those are related to deployment exposures and that those service members need to receive benefits. So that’s another important thing, I think, for us to just be aware of that, that this is an important act. It recognizes that there is risk of respiratory injury and that we have to monitor people over time to make sure that that we catch any other respiratory disease complications early on, while there’s still an opportunity to treat them.

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