Between 2003 and 2005, Vanderbilt physicians treated more than 50 soldiers from the 101st Airborne Division based in Fort Campbell, Ky., with a common complaint. Each soldier had a history of shortness of breath, and each one—a former supremely fit soldier—was having trouble passing a running test. They also shared similar stories of exposure to massive amounts of smoke from sulfur fires in 2003 or breathing air fouled by dust and smoke from burn pits across Iraq.
Dr. Robert Miller, MD’82, associate professor of allergy, pulmonary and critical care medicine, made what he calls an “unconventional” move to recommend surgical biopsies for these soldiers without tests containing tangible evidence of disease.
His hunch paid off. “So far, all but a few of these soldiers we have biopsied have come back with pathology diagnosing constrictive bronchiolitis,” Miller says. Constrictive bronchiolitis is a narrowing of the tiniest and deepest airways of the lungs. It is rare and can only be diagnosed through biopsy. Cases documented in the medical literature show striking similarities to what is seen in these soldiers’ biopsies.
“These are inhalation injuries suffered in the line of duty,” says Miller, who with his colleagues has been building evidence, testifying before Congress, and reaching out to the military to explore concerns that soldiers are being exposed to airborne toxins in Iraq and Afghanistan that leave them with potentially permanent lung damage.
Dr. Joyce Johnson, MD’86, professor of pathology, has been working with Miller to examine the soldiers’ biopsies. She has built up a slide file jammed with hundreds of micro-thin “slices” taken from dozens of soldiers’ biopsies.
“These are striking abnormalities in this otherwise young and healthy population,” says Johnson. “We need broad, national recognition that this is a complication of being in this theater.”
During the past three years, attention to the work of the Vanderbilt team has gained momentum. In 2007 the Army Public Health Command requested information from Miller to launch an investigation of exposures to soldiers during the Mishraq sulfur fires. In May 2008, Miller and Dr. Matthew King, a resident in the Division of Allergy, Pulmonary and Critical Care Medicine, presented their findings at an American Thoracic Society (ATS) meeting.
By October 2009 there was growing national alarm about the huge Balad burn pit as servicemen and women exposed to the fires reported a growing number of illnesses, including cancers. Miller testified before a congressional hearing committee Oct. 8, 2009. Three weeks later the National Defense Authorization Act passed, including a law prohibiting disposal of medical or hazardous waste in open-air burn pits.
In November 2009, William Valentine, associate professor of pathology and a member of the Vanderbilt Center in Molecular Toxicology, was invited to sit on an Institute of Medicine’s National Academies committee to study long-term health consequences of exposure to burn pits in Iraq and Afghanistan. Additionally, Miller, King and Dr. James Tolle, assistant professor of medicine, have traveled to National Jewish Health Hospital in Denver to work with a group of medical and military experts examining the range of exposures and respiratory complaints reported by soldiers returning from the war in both Iraq and Afghanistan.
“The message is: Now is the time to figure out this post-deployment respiratory illness,” says King. “There is a lot of concern that this is the tip of the iceberg. We are asking what’s causing these illnesses and what prevention and management can we offer soldiers in the future.”
Miller hopes Vanderbilt can be instrumental in designing a test to identify the likelihood of constrictive bronchiolitis without having to open up the chests of any more soldiers. “I believe these people have paid a huge price to serve as much as they have served, and if they are now as limited as we are observing, they deserve the best of care.”