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Researchers link Iraq dust with some vets' lung problems

Mar. 7, 2014 - 10:44AM   |  
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Researchers at Stony Brook University in New York have coined the term “Iraq-Afghanistan war lung injury” to describe respiratory symptoms developed by some veterans — and they have duplicated the problem in mice, using dust from Camp Victory in Baghdad.

In an article published Friday in the Journal of Occupational and Environmental Medicine, researchers including Dr. Anthony Szema, an allergist and assistant professor of medicine at Stony Brook, found that exposing mice to dust collected from Camp Victory in 2007 produced inflammation and changes to respiratory airways similar to those found in Iraq veterans diagnosed with constrictive bronchiolitis.

The mice lungs contained “angular, sharp and solid” particles with traces of titanium and iron, according to the study.

Replicating the experiment with dust from other locations, including the San Joaquin Valley in California; Kandahar, Afghanistan; and a titanium mine in Montana, the researchers could not produce the same inflammatory response.

“Respirable Iraq dust leads to lung inflammation in mice similar to that seen in patients, with polarizable crystals, which seem to be titanium,” the study concludes, referring to several of Szema’s patients — veterans found to have titanium and iron in their lungs following tissue analysis.

A massive, Pentagon-funded population study called the Millennium Cohort Study found that 14 percent of troops who deployed to Iraq report experiencing chronic respiratory symptoms such as cough, bronchitis, shortness of breath and asthma starting during deployment or afterward, compared with 10 percent who did not deploy.

Some service members were sickened during exposure to fumes from a sulfur mine fire that burned near Mosul, Iraq, in 2003 while others have blamed the military’s use of open-air burn pits to dispose of waste — pits that produced fumes containing dioxin, volatile organic compounds and other contaminants.

But Szema’s research focused solely on the region’s dust to produce results, indicating it may play a significant role in troops’ respiratory illnesses.

“Although a plethora of airborne hazards may have been experienced by military personnel during deployment to Iraq — detonation of mortars, improvised explosive devices, vehicle IEDs, over-pressure from shock waves, dust and sand storms, fumes from burning trash with jet fuel, indoor and outdoor allergens, infection vectors from organic components in the dust and air — our model allows the isolation of dust and the ability to examine its sundry inorganic components and their effect on lung health,” researchers said.

Szema has examined 1,787 Long Island, N.Y.-based Iraq and Afghanistan veterans and, like the Millennium Cohort Study, found that 14 percent have respiratory symptoms.

The study, “Iraq Dust is Respirable, Sharp and Metal-Laden and Induces Lung Inflammation with Fibrosis in Mice,” appears to support previous work by Navy Capt. Mark Lyles, a professor of health and security studies at the Naval War College in Newport, R.I., on soil dust with one notable exception: Lyles, who found that soil and dust samples from the Persian Gulf region contained microscopic particles carrying microbes and 37 elements and metals, found particles that were hollow while Szema’s contaminants were solid.

Szema said this is important because it means the matter he found in the lungs couldn’t carry other potential sources of illness, such as microbes or nano-contaminants.

Regardless, Lyles has described the dust of Iraq as the “smoking gun” for lung problems in veterans such as constrictive bronchiolitis, a rare, irreversible disease characterized by inflammation and scarring in the lungs’ smallest airway branches.

“I think the more people concentrate on the burn pits ... the more they dilute the number of people who actually were exposed to environmental toxins,” Lyles said. “I believe only 3 to 5 percent of service members were exposed to a burn pit. But 100 percent of people who served were exposed to mineralized dust.

Since 2012, the Defense Department has held two closed-door meetings in Washington, D.C., to discuss deployment-related airborne pollution. The Joint VA-DoD Airborne Hazards Symposium aims to guide current handling of troops and veterans exposed to potential toxins “and improve future efforts in environmental exposure assessment, clinical surveillance, medical testing and research,” according to their agendas.

Last month, DoD spokeswoman Army Lt. Col. Catherine Wilkinson said the department is working to develop screening tools for troops and veterans with symptoms, as well as diagnostic tools to identify disease.

“We take seriously the concerns associated with exposure to airborne hazards, and continue to study possible long-term health effects of this type of exposure during deployments,” Wilkinson said.

Szema said more work must be done to understand the role dust plays in combination with other exposures. He noted that his study was small, focusing only on a handful of mice, and limited, because it used just dust samples from a Baghdad base.

But in an interview with Military Times, Szema said that because only half of his 107 patients with new airway obstructions respond to asthma medications and many face lifelong health problems, new research should be funded to find ways to help these veterans.

“Based on what we know the injury is, we need to assess [troops] for titanium and look at new drugs to block the effects of the dust,” Szema said.

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