Dr. Krefft is a resident, Dr. Nawaz is an associate professor, and Dr. Miller is a professor of medicine, all at the University of Colorado Anschutz Medical Campus in Aurora. Dr. Rose is also an associate professor at the University of Colorado in Denver. Dr. Miller and Dr. Nawaz are also physicians at the VA Eastern Colorado Health Care System in Denver.
Referral for surgical lung biopsy was particularly helpful in the first case, because it ruled out other lung diseases that are more responsive to systemic therapy. However, referral for surgical lung biopsy is not recommended in all patients, and in-depth discussion of the risks and benefits associated with surgery is recommended. Although diagnostic clarity is a benefit of surgical lung biopsy, the authors also discuss with patients that there is no currently available therapy for deployment-related lung disease and thus management is unlikely to change after biopsy. The recommended approach to diagnostic evaluation is shown in Figure 4.
In the authors’ experience, treatment of deployment-related asthma with standard asthma treatment usually improves or stabilizes respiratory symptoms but often does not result in complete resolution of symptoms. Improvement in lung function with systemic pharmacotherapy in the management of deployment-related lung diseases, such as constrictive bronchiolitis, respiratory bronchiolitis, emphysema, or granulomatous pneumonitis has not been observed. Although little is currently known about prognosis, utilization of data collected from the VA Airborne Hazards and Open Burn Pit Registry may contribute to the understanding of deployment exposures and long-term respiratory health effects.
Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.
