Study of Active Duty Military for Pulmonary Disease Related to Environmental Deployment Exposures (STAMPEDE)
Study of Active Duty Military for Pulmonary Disease Related to Environmental Deployment Exposures (STAMPEDE)
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DOI：
10.1164/rccm.201402-0372oc
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发表时间：
2014-07-01
影响因子：
24.7
通讯作者：
Zacher, Lisa L.
中科院分区：
文献类型：
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作者：
Morris, Michael J.;Dodson, Darrel W.;Zacher, Lisa L.
理由：由于西南亚地区空气中颗粒物含量增加，部署的军事人员有患急性和慢性肺部疾病的风险。有呼吸道症状加重的报告，但关于已报告的肺部疾病的数据有限。目的：评估从西南亚返回的军事人员的新呼吸道疾病，以确定症状的潜在病因。方法：对归国军事人员在返回工作地点后6个月内进行与部署有关的呼吸道症状的前瞻性标准化评估。测量方法和主要结果：前瞻性标准化评价包括全肺功能检查、高分辨率胸部断层扫描、甲胆碱激发试验和支气管肺泡灌洗纤维支气管镜检查。其他手术包括肺活检，如果临床指征。50名患者完成了研究程序。很大比例（42%）仍未确诊，其中12%检测正常，单独的灌洗液中性粒细胞或淋巴细胞增加。20例（40%）患者表现出气道高反应性，其中8例符合哮喘标准，2例继发于胃食管反流。另外4例（8%）患者有孤立性弥散能力降低，其余6例有其他各种气道疾病。没有患者在计算机断层成像的基础上被确定为弥漫性实质疾病。该队列中相当多（66%）的人有潜在的精神健康和睡眠障碍。结论：对西南亚地区服役后军事人员新呼吸道症状的评估应侧重于暴露于较高水平的环境颗粒物引起的气道过度反应性。这些患者可能难以诊断，需要密切随访。
Rationale: Because of increased levels of airborne particulate matter in Southwest Asia, deployed military personnel are at risk for developing acute and chronic lung diseases. Increased respiratory symptoms are reported, but limited data exist on reported lung diseases.Objectives: To evaluate new respiratory complaints in military personnel returning from Southwest Asia to determine potential etiologies for symptoms.Methods: Returning military personnel underwent a prospective standardized evaluation for deployment-related respiratory symptoms within 6 months of returning to their duty station.Measurements and Main Results: Prospective standardized evaluation included full pulmonary function testing, high-resolution chest tomography, methacholine challenge testing, and fiberoptic bronchoscopy with bronchoalveolar lavage. Other procedures including lung biopsy were performed if clinically indicated. Fifty patients completed the study procedures. A large percentage (42%) remained undiagnosed, including 12% with normal testing and an isolated increase in lavage neutrophils or lymphocytes. Twenty (40%) patients demonstrated some evidence of airway hyperreactivity to include eight who met asthma criteria and two with findings secondary to gastroesophageal reflux. Four (8%) additional patients had isolated reduced diffusing capacity and the remaining six had other miscellaneous airway disorders. No patients were identified with diffuse parenchymal disease on the basis of computed tomography imaging. A significant number (66%) of this cohort had underlying mental health and sleep disorders.Conclusions: Evaluation of new respiratory symptoms in military personnel after service in Southwest Asia should focus on airway hyperreactivity from exposures to higher levels of ambient particulate matter. These patients may be difficult to diagnose and require close follow-up.