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Military personnel and veterans who have deployed to Afghanistan, Iraq, and parts of Southwest Asia (SWA) since 1990 are at risk of developing a host of respiratory symptoms and deployment-related respiratory diseases (DRRDs). This review aims to summarize our current understanding of DRRD and inform pulmonary practitioners of recent updates to DRRD screening, diagnosis, evaluation, and management. The most common respiratory diseases in these patients include asthma, chronic sinonasal disease, laryngeal disease/dysfunction, and distal lung disease. Pulmonary function testing and chest imaging are the most commonly used diagnostic tools, but techniques such as lung clearance index testing via multiple breath washout, forced oscillation testing/impulse oscillometry, and quantitative chest computed tomography (CT) assessment appear promising as noninvasive modalities to aid in lung disease detection in this population. We also summarize guidance on conducting an occupational and deployment exposure history as well as recommendations for testing. Finally, we discuss the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act) that includes a list of health conditions that are “presumptively” considered to be related to SWA military deployment toxic exposures, and provide resources for clinicians who evaluate and treat patients with DRRD.

Case Presentation A 28-year-old man presented with shortness of breath, chest pain, and scant hemoptysis. Three weeks previously, he was admitted for coronavirus disease 2019 pneumonia that had been diagnosed by nasal swab polymerase chain reaction. Chest CT imaging demonstrated bilateral ground-glass opacities without evidence of VTE. He was treated with hydroxychloroquine, up to 7 L/min oxygen, and self-proning. After 8 days of hospitalization, he was discharged on 4 L/min oxygen. After discharge, his symptoms and hypoxia resolved.

OBJECTIVE The aim of this study was to determine utility and sensitivity of lung clearance index (LCI) testing as a marker of lung injury in symptomatic military deployers compared with healthy controls. METHODS We tested 24 healthy controls and 28 deployers with respiratory symptoms (17 of 28 with definite and 11 of 28 with probable deployment-related lung disease). We compared mean LCI scores between deployers and controls using t tests; adjusted tests were derived from multiple regression models. RESULTS Mean LCI scores were significantly higher (P = 0.001) in deployers [7.76, 95% confidence interval (95% CI) 7.34 to 8.17] than controls (6.95, 95% CI 6.73 to 7.17). Adjusting for body mass index (BMI), smoking, and age, there were no significant differences (P = 0.10) between mean LCI scores in deployers (7.42, 95% CI 7.13 to 7.71) and controls (7.06, 95% CI 6.74 to 7.39). CONCLUSIONS The trend toward higher LCI scores in symptomatic deployers may be linked to underlying lung disease and/or BMI but requires further investigation in a larger population.

Rationale: An unknown number of post–9/11 military deployers to Iraq and Afghanistan have returned with respiratory symptoms and may be at risk for deployment-related distal lung disease, detected ...