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, a new study suggests.

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 told Reuters Health in a telephone interview.

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 percent 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 percent in a test of how much of the air in their lungs they could expel in one second, compared with 99 percent in the control group.

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

BOSTON -- Rachel Caesar, a career soldier and mother of two teenage boys, spent nine months in Afghanistan serving her country. When she came home, her experiences still haunted her.

“I was at the hospital one day and I saw a child about my kids' age who was burnt from a land mine. And I kept having dreams about that," said Caesar. “I could only sleep during the day because at nighttime I was having nightmares," said Caesar.
Eventually, Rachel was diagnosed with depression and post-traumatic stress disorder (PTSD), which one in five returning veterans deal with once back at home.

New research out of Canada, however, may hold the key to preventing PTSD before it even begins. Relief could come in the form of a pill that blocks a patient's ability to recall bad memories.

“The goal is really to reduce bad memories that prevent people from living normally,” said Marie-France Marin, the lead author of the study and a doctoral student at the Centre for Studies on Human Stress of Louis-H. Lafontaine Hospital in Quebec, Canada.

When in a stressful environment, such as a war zone, the body releases the stress hormone cortisol. Too much or too little cortisol affects memory function too.
In one study, Canadian researchers gave a group of men the drug metyrapone, known to lower cortisol levels, after showing the men both neutral and negative images.

“What we notice is that people who recalled the story under two doses of metyrapone have lower memory for emotional segments of the story, but the neutral memories are not affected,” said Marin.

The negative memories were gone, even days later when the drug was out of their systems. The neutral memories remained unaffected. To Caesar and other veterans, the research means hope.

“I would love to forget how I was treated, a lot of things that went on,” said Caesar.
One major hurdle to the research, however, is that metyrapone is no longer commercially produced. Even so, researchers said the study's success may motivate pharmaceutical companies to re-invest in the drug.