Respiratory Health after Military Service in Southwest Asia and Afghanistan An Official American Thoracic Society Workshop Report
Respiratory Health after Military Service in Southwest Asia and Afghanistan An Official American Thoracic Society Workshop Report
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DOI：
10.1513/annalsats.201904-344ws
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发表时间：
2019-08-01
影响因子：
8.3
通讯作者：
Blanc, Paul D.
中科院分区：
文献类型：
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作者：
Garshick, Eric;Abraham, Joseph H.;Blanc, Paul D.
自2001年以来，已有超过270万名美国军事人员部署在西南亚和阿富汗的行动中。陆基人员经历了来自多种来源的颗粒物和其他吸入性暴露的增加，包括沙漠粉尘、燃烧坑燃烧和其他工业、移动或军事来源。在2018年美国胸科学会国际会议上举办的一个研讨会的目标是：1)确定评估部署后呼吸健康的关键研究，2)描述新出现的研究，以及3)突出知识差距。研讨会回顾了流行病学研究，这些研究表明，与非部署人员相比，部署后的呼吸道症状和呼吸道疾病(主要是哮喘)更频繁地发生，以及描述部署后呼吸困难、哮喘和一系列其他呼吸道表现的病例系列。根据其他人群中的颗粒物效应，部署人员也可能因这种暴露而经历肺功能下降。研讨会还特别关注缩窄性毛细支气管炎，在选定的部署人员的肺活检中报告了这种情况。研讨会参与者对缩窄性毛细支气管炎的定义和频率以及部署人群中的其他小气道病理结果有不同的看法。研讨会的结论是，包括缩窄性毛细支气管炎在内的呼吸道疾病与部署期间暴露的关系仍有待更好地界定。未来的临床和流行病学研究工作应针对部署暴露的更好特征；对潜在相关的不良健康状况进行纵向评估，包括肺功能和其他生理变化；并对呼吸道异常患者使用严格的组织学、暴露和临床特征。
Since 2001, more than 2.7 million U.S. military personnel have been deployed in support of operations in Southwest Asia and Afghanistan. Land-based personnel experienced elevated exposures to particulate matter and other inhalational exposures from multiple sources, including desert dust, burn pit combustion, and other industrial, mobile, or military sources. A workshop conducted at the 2018 American Thoracic Society International Conference had the goals of: 1) identifying key studies assessing postdeployment respiratory health, 2) describing emerging research, and 3) highlighting knowledge gaps. The workshop reviewed epidemiologic studies that demonstrated more frequent encounters for respiratory symptoms postdeployment compared with nondeployers and for airway disease, predominantly asthma, as well as case series describing postdeployment dyspnea, asthma, and a range of other respiratory tract findings. On the basis of particulate matter effects in other populations, it also is possible that deployers experienced reductions in pulmonary function as a result of such exposure. The workshop also gave particular attention to constrictive bronchiolitis, which has been reported in lung biopsies of selected deployers. Workshop participants had heterogeneous views regarding the definition and frequency of constrictive bronchiolitis and other small airway pathologic findings in deployed populations. The workshop concluded that the relationship of airway disease, including constrictive bronchiolitis, to exposures experienced during deployment remains to be better defined. Future clinical and epidemiologic research efforts should address better characterization of deployment exposures; carry out longitudinal assessment of potentially related adverse health conditions, including lung function and other physiologic changes; and use rigorous histologic, exposure, and clinical characterization of patients with respiratory tract abnormalities.