Pulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX.
Pulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX.
Chest. 2020 Jun;157(6):1559-1567. doi: 10.1016/j.chest.2020.01.024. Epub 2020 Feb 1.
Chronic respiratory symptoms are frequently reported after Southwest Asia deployment in support of combat operations. The full spectrum of clinical lung diseases related to these deployments is not well characterized.
Military personnel with chronic symptoms, primarily exertional dyspnea, underwent a standardized cardiopulmonary evaluation at two tertiary medical centers. Pulmonary function testing consisted of spirometry, lung volume, diffusing capacity, impulse oscillometry, and bronchodilator testing. Further testing included methacholine challenge, exercise laryngoscopy, high-resolution CT scan, ECG, and transthoracic echocardiography.
A total of 380 participants with a mean age of 38.5 ± 8.4 years completed testing. Asthma was the most common diagnosis in 87 patients (22.9%) based on obstructive spirometry/impulse oscillometry and evidence of airway hyperreactivity, whereas another 57 patients (15.0%) had reactivity with normal spirometry. Airway disorders included 25 (6.6%) with laryngeal disorders and 16 (4.2%) with excessive dynamic airway collapse. Interstitial lung disease was identified in six patients (1.6%), whereas 11 patients (2.9%) had fixed obstructive lung disorders. Forty patients (10.5%) had isolated pulmonary function abnormalities and 16 (4.2%) had miscellaneous disorders. The remaining 122 patients (32.1%) with normal studies were classified as undiagnosed exertional dyspnea. Significant comorbidities identified included elevated BMI > 30 kg/m (34.2%), smoking (36.4%), positive allergy testing (43.7%), sleep apnea (38.5%), and esophageal reflux (13.6%). Mental health disorders and posttraumatic stress disorder were likewise common.
Postdeployment pulmonary evaluation should focus on common diseases, such as asthma and airway hyperreactivity, and include testing for upper airway disorders. Diffuse lung diseases were rarely diagnosed, whereas numerous comorbidities were common.
在支持作战行动的西南亚部署后，经常报告有慢性呼吸道症状。与这些部署相关的临床肺部疾病的全貌尚未得到很好的描述。
有慢性症状（主要是运动性呼吸困难）的军人在两个三级医疗中心接受了标准化心肺评估。肺功能测试包括肺活量测定、肺容积、弥散量、脉冲振荡和支气管扩张剂测试。进一步的测试包括乙酰甲胆碱挑战、运动喉镜检查、高分辨率 CT 扫描、心电图和经胸超声心动图。
共有 380 名平均年龄为 38.5±8.4 岁的参与者完成了测试。根据阻塞性肺活量测定/脉冲振荡和气道高反应性的证据，哮喘是 87 名患者（22.9%）中最常见的诊断，而另外 57 名患者（15.0%）的肺活量测定正常但有反应性。气道疾病包括 25 名（6.6%）有喉疾病和 16 名（4.2%）有过度动态气道塌陷。间质性肺疾病在 6 名患者（1.6%）中得到确认，而 11 名患者（2.9%）有固定阻塞性肺部疾病。40 名患者（10.5%）有孤立性肺功能异常，16 名患者（4.2%）有多种疾病。其余 122 名（32.1%）检查正常的患者被归类为未确诊的运动性呼吸困难。确定的显著合并症包括 BMI 升高>30kg/m（34.2%）、吸烟（36.4%）、阳性过敏测试（43.7%）、睡眠呼吸暂停（38.5%）和食管反流（13.6%）。精神健康障碍和创伤后应激障碍也很常见。
部署后肺部评估应侧重于常见疾病，如哮喘和气道高反应性，并包括上气道疾病的测试。弥漫性肺部疾病很少被诊断，而许多合并症则很常见。
