title: Constrictive bronchiolitis in soldiers returning from Iraq and Afghanistan.
abstract: BACKGROUND
  In this descriptive case series, 80 soldiers from Fort Campbell, Kentucky, with inhalational exposures during service in Iraq and Afghanistan were evaluated for dyspnea on exertion that prevented them from meeting the U.S. Army's standards for physical fitness.
  
  
  METHODS
  The soldiers underwent extensive evaluation of their medical and exposure history, physical examination, pulmonary-function testing, and high-resolution computed tomography (CT). A total of 49 soldiers underwent thoracoscopic lung biopsy after noninvasive evaluation did not provide an explanation for their symptoms. Data on cardiopulmonary-exercise and pulmonary-function testing were compared with data obtained from historical military control subjects.
  
  
  RESULTS
  Among the soldiers who were referred for evaluation, a history of inhalational exposure to a 2003 sulfur-mine fire in Iraq was common but not universal. Of the 49 soldiers who underwent lung biopsy, all biopsy samples were abnormal, with 38 soldiers having changes that were diagnostic of constrictive bronchiolitis. In the remaining 11 soldiers, diagnoses other than constrictive bronchiolitis that could explain the presenting dyspnea were established. All soldiers with constrictive bronchiolitis had normal results on chest radiography, but about one quarter were found to have mosaic air trapping or centrilobular nodules on chest CT. The results of pulmonary-function and cardiopulmonary-exercise testing were generally within normal population limits but were inferior to those of the military control subjects.
  
  
  CONCLUSIONS
  In 49 previously healthy soldiers with unexplained exertional dyspnea and diminished exercise tolerance after deployment, an analysis of biopsy samples showed diffuse constrictive bronchiolitis, which was possibly associated with inhalational exposure, in 38 soldiers.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Meharry Medical College, Nashville, TN, USA.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: King
authors.forename: Rosana
authors.initials: R
authors.lastname: Eisenberg
authors.forename: John H
authors.initials: JH
authors.lastname: Newman
authors.forename: James J
authors.initials: JJ
authors.lastname: Tolle
authors.forename: Frank E
authors.initials: FE
authors.lastname: Harrell
authors.forename: Hui
authors.initials: H
authors.lastname: Nian
authors.forename: Mathew
authors.initials: M
authors.lastname: Ninan
authors.forename: Eric S
authors.initials: ES
authors.lastname: Lambright
authors.forename: James R
authors.initials: JR
authors.lastname: Sheller
authors.forename: Joyce E
authors.initials: JE
authors.lastname: Johnson
authors.forename: Robert F
authors.initials: RF
authors.lastname: Miller
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D055745:Bronchioles / Q000473:pathology*; D001989:Bronchiolitis Obliterans / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D005080:Exercise Test; D017079:Exercise Tolerance; D005500:Follow-Up Studies; D006801:Humans; D054542:Iraq War, 2003-2011; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008889:Military Personnel; D015995:Prevalence; D012129:Respiratory Function Tests; D014057:Tomography, X-Ray Computed; D014481:United States