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Lung damage in Iraq and Afghanistan veterans

Shortness of breath and reduced fitness among some military veterans returning from Iraq and Afghanistan may be caused by lung damage from smoke, sandstorms and toxins, new research from the US has suggested.

Researchers who performed lung biopsies on 38 veterans with unexplained breathing problems found a form of tissue damage – called constrictive bronchiolitis – that is rare in young adults and doesn’t show up in standard tests.

In all but one case, a “lacy black pigment” also coated the delicate lung surfaces.

Dr Robert Miller of the Vanderbilt University Medical Center said the cases, which he has been gathering for years, are apparently caused by exposure to airborne toxins during deployment.

“We believe they’re deployed to some pretty toxic environments. They’re exposed to burning solid waste, burning human waste (particularly in Iraq), and consistently exposed to fine particulate matter that’s easily inhaled deep into the lungs at a level that’s above what’s desirable,” Miller stated.

Dust storms and combat smoke may also be a factor. Previous research has suggested that service in the Middle East increases the risk of breathing problems.

Among the volunteers examined in the new study – primarily members of the 101st Airborne Division in Fort Campbell, Kentucky – most had long-term exposure to a sulfur-mine fire that burned for 30 days in 2003 near Mosul, Iraq, Miller and his colleagues write in the New England Journal of Medicine.

In all, Miller’s team tested 80 previously fit soldiers who no longer met the Army’s physical fitness standards.

Forty-nine agreed to undergo an invasive lung biopsy procedure after chest X-rays and other standard tests did not reveal the cause of their problems.

All 49 had tissue samples that were judged to be abnormal. The diagnosis of constrictive bronchiolitis – a thickening of the walls of the smallest lung passages, the bronchioles – was made in 38 cases (35 men and three women). Seven were active smokers and six were former smokers.

The condition doesn’t show up in standard tests of breathing capacity, according to Miller, because the soldiers probably begin their deployment with so much extra lung function – perhaps 115 per cent of normal – that their damaged lungs still perform in a range that’s considered normal for non-athletes.

But when compared to a sample of 69 unaffected active duty soldiers, the soldiers Miller examined had weaker lung function – averaging 87 per cent in a test of how much of the air in their lungs they could expel in one second, compared with 99 per cent in the control group.

Of the 38 diagnosed with constrictive bronchiolitis, half left the service with a disability rating and 58 per cent reported having shortness of breath after climbing one flight of stairs.

“My concern is there are too many people whose symptoms are being dismissed because their X-rays and pulmonary function tests are normal or near normal,” he said. “My personal agenda is to get these guys seriously evaluated.”

The lung biopsies performed in Miller’s study require more than a month of recovery time and cost $50,000 to $60,000. And there is no treatment for the soldiers’ condition, Miller said. “It’s a fixed scarring of the small airway. It’s not irritation, inflammation or swelling.”

Nonetheless, Miller wants doctors to keep his findings in mind.

“If you have someone with unexplained shortness of breath who served in the Middle East, you have to consider constrictive bronchiolitis as a possible cause, even if X-rays and pulmonary function tests are normal,” he said.

Earlier results with a smaller number of cases were reported in 2008 at a meeting of the American Thoracic Society.

“Now we feel we have enough patients to say, ‘This is real,'” Miller said.

Plan to rid world of polio is “off track”

A plan to rid the world of polio by the end of next year is “off track”, according to international experts.

India is praised for having had just one case of polio in the first six months of this year however the independent report warns that Pakistan “risks becoming the last global outpost of this vicious disease”. It has also resurfaced in four other countries.

There were around 1,000 cases of polio worldwide last year.

The virus remains present in Afghanistan, India, Nigeria and Pakistan and in the countries where it has resurfaced, there have been twice as many cases – 162 – as there were in the endemic countries.

The experts are particularly concerned about new cases in the Democratic Republic of Congo and Chad.

England’s former chief medical officer, Sir Liam Donaldson, is leading the board monitoring the efforts of the Global Polio Eradication Initiative, which works to support the goal set in 1988.

Sir Liam said: “Polio is a very resilient disease. There was a big impact in tackling it in the first two decades since the goal.

“But we still have this very big rump of cases left behind. Tackling the remaining 1 per cent of polio is the greatest challenge yet.

“India has done something simple – it’s run very high quality vaccination campaigns. They have public health leaders who are meticulous in making sure every child is vaccinated.

“If they can do it, why can’t other countries?”

Polio is highly infectious – and tends to strike children aged under five. It invades the nervous system, leading to irreversible paralysis.

There is no cure, but a vaccine of mouth droplets can give good protection

Sir Liam and his colleagues say strong political and community leadership is important in the countries with polio outbreaks. They also identify a funding gap of £366m.

The report highlights problems that occur within some vaccination programmes. In one part of Pakistan, paid vaccinators had sub-contracted their tasks to untrained children.

And in another campaign, the vaccinators stood passively at their post in the town square, rather than mingling with the crowds and encouraging immunisation.

The monitoring board said: “Our view remains that stopping polio transmission needs to be treated as a global health emergency.

“Fourteen countries have had polio outbreaks since the start of 2010. It is alarming and bad for the programme’s morale that there are still these surprises.

“Polio eradication is still possible in the near-term if there is enhanced political commitment, secure funding and strengthened technical capacity.”

Rotary International, which is part of the Eradication Initiative, said: “We welcome this frank assessment of the programme.

“We will work with our members in countries affected by polio to follow the board’s recommendation of creating a checklist, to enhance the impact of the immunisation teams and ensure standardisation.”


Marriage is good for your health

Research suggests that marriage is good for your health – especially if you’re a man. Married men tend to live longer than their unwed counterparts, they’re more likely to see their doctor regularly, and they even have a lower risk of dying from a heart attack or stroke.

A new study found that men who experience chest pains while having a heart attack tend to get to a hospital sooner if they’re married or in a common-law relationship.

A woman’s marital status, by contrast, was not associated with how quickly she sought treatment after experiencing heart-attack-related chest pains, according to the study, which was published today in the Canadian Medical Association Journal.

One reason for this discrepancy may be that, traditionally, women tend to assume the caregiver role in a relationship and may be more likely to insist that their husbands seek medical care than vice versa, says the lead author of the study, Dr Clare Atzema, a researcher at the Institute for Clinical Evaluative Sciences in Ontario.

The caregiving role many women play in their marriages is so ubiquitous and ingrained that a wife might not even need to be physically present during a heart attack to have a good influence on her husband, Dr Atzema said.

“The man, just knowing that when his wife gets back and finds out that he had a heart attack and waited five, six hours — his anticipation of that may make him seek care more quickly and effectively than the actual chest pain will,” she added.


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