# Post-Deployment Respiratory Syndrome in Veterans of Iraq and Afghanistan

> **NIH VA I50** · VETERANS HEALTH ADMINISTRATION · 2024 · —

## Abstract

PROJECT SUMMARY
 More than 2.7 million military service members have deployed to Iraq or Afghanistan since 2001.
Compared to non-deployed personnel, Veterans of these conflicts have a higher prevalence of exertional
dyspnea and other respiratory symptoms which may relate to exposure to inhalational irritants during
deployment. While many of these patients have asthma or other common respiratory conditions, approximately
one-third remain undiagnosed with a traditional lung disease despite an extensive pulmonary evaluation. In a
case series reported by our group in the New England Journal of Medicine in 2011, 38/49 such Veterans were
diagnosed with constrictive bronchiolitis (CB) after surgical lung biopsy. Although more than a decade has
passed since this initial report, no follow-up study has been performed to define the clinical evolution of
disease in these Veterans. Further, no study has been performed to link development of constrictive
bronchiolitis to specific exposures - either self-reported or quantified in lung tissue samples. Finally, although
constrictive bronchiolitis was included in the recently passed PACT Act, there is currently no means of
establishing this diagnosis outside of a surgical lung biopsy which is costly and carries significant morbidity and
some mortality.
 Our published and preliminary data suggest that lung biopsies from Veterans with DR-CB have chronic
activation of adaptive immunity which is associated with progressive airflow obstruction. Further, these findings
occur in association with widespread deposition of polarizable and non-polarizable pigmented material
containing foreign elements such as lead, silicon, strontium, and titanium. These data led us to hypothesize
that persistent elemental species in the lungs of Veterans with DR-CB drive ongoing adaptive immune
activation and progressive airflow obstruction. Further, we hypothesize that new imaging-based techniques can
diagnose DR-CB without a surgical lung biopsy. To test these hypotheses, we will 1) identify and quantify trace
elements in the lungs of Veterans with DR-CB, Veterans without DR-CB, and civilian controls, and correlate
these levels with morphometric measurements of lung pathology and the surrounding immune response; 2)
determine whether Veterans who were diagnosed with DR-CB have a higher prevalence of progressive
cardiopulmonary disease than those without DR-CB; and 3) establish non-invasive, radiology-based methods
of diagnosing DR-CB and monitoring for disease progression. Together, these studies will positively impact
Veterans by advancing our understanding of factors which may promote DR-CB development, rigorously
assessing cutting-edge diagnostic modalities which may improve our ability to diagnose DR-CB non-invasively,
informing our understanding of disease progression, and creating new surrogate endpoints for future clinical
trials.

## Key facts

- **NIH application ID:** 10735288
- **Project number:** 1I50CX002551-01A1
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Bradley Winston Richmond
- **Activity code:** I50 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2024-06-01 → 2029-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10735288

## Citation

> US National Institutes of Health, RePORTER application 10735288, Post-Deployment Respiratory Syndrome in Veterans of Iraq and Afghanistan (1I50CX002551-01A1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10735288. Licensed CC0.

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