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Since 2001, more than 2.7 million U.S. military personnel have been deployed in support of operations in Southwest Asia and Afghanistan. Land-based personnel experienced elevated exposures to particulate matter and other inhalational exposures from multiple sources, including desert dust, burn pit combustion, and other industrial, mobile, or military sources. A workshop conducted at the 2018 American Thoracic Society International Conference had the goals of: 1 ) identifying key studies assessing postdeployment respiratory health, 2 ) describing emerging research, and 3 ) highlighting knowledge gaps. The workshop reviewed epidemiologic studies that demonstrated more frequent encounters for respiratory symptoms postdeployment compared with nondeployers and for airway disease, predominantly asthma, as well as case series describing postdeployment dyspnea, asthma, and a range of other respiratory tract findings. On the basis of particulate matter effects in other populations, it also is possible that deployers experienced reductions in pulmonary function as a result of such exposure. The workshop also gave particular attention to constrictive bronchiolitis, which has been reported in lung biopsies of selected deployers. Workshop participants had heterogeneous views regarding the definition and frequency of constrictive bronchiolitis and other small airway pathologic findings in deployed populations. The workshop concluded that the relationship of airway disease, including constrictive bronchiolitis, to exposures experienced during deployment remains to be better defined. Future clinical and epidemiologic research efforts should address better characterization of deployment exposures; carry out longitudinal assessment of potentially related adverse health conditions, including lung function and other physiologic changes; and use rigorous histologic, exposure, and clinical characterization of patients with respiratory tract abnormalities.

Objective: To review the Veterans Affairs (VA) medical surveillance program for Veterans with potential hexavalent chromium (CrVI) exposure that occurred during 2003., Methods: Retrospective review of medical records of the 124 Veterans that participated in standardized, in-person clinical evaluations for possible CrVI exposure during the incident in question. The evaluations were reviewed to define population level effects. In addition, a mortality analysis was conducted for the 808 unique personal identifiers available to Veterans Health Administration., Results: Mean reported number of days exposed was 21 (median 10). A history of respiratory (n = 78) and skin (n = 38) symptoms were reported during the period of exposure. No abnormalities that were specific to chromium exposure (e.g., nasal septum perforation) were found. Eight deaths occurred between 2005 and 2012., Conclusions: The lack of severe nasal abnormalities in the VA evaluations supports a time-limited peak exposure. However, the overall low participation rate (15%) severely compromises any ability to generalize to the entire potentially exposed population. Regardless, since the actual level of exposure to CrVI will never be known with certainty, the VA will continue to monitor these Veterans with periodic evaluations to identify and manage any pathologic findings that might be associated with past CrVI exposure., (Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.)