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Does MBW Have Utility in Evaluating Exposure-Related Airways Disease in Symptomatic Military Personnel following Deployment to Austere Environments?

Research Paper Title

Multiple breath washout: A non-invasive tool for identifying lung disease in symptomatic military deployers.

Background

Military deployments to austere environments since 09 November 2001 may put "deployers" at risk for respiratory disease. Sensitive, non-invasive tools for detecting large and small airways injury are needed to identify early disease and help inform management for this at-risk population.

The researchers examined multiple breath washout (MBW) as a tool for identifying deployment-related airways disease and assessed host and exposure risk factors compared to healthy controls.

Methods

Between March 2015 and March 2020, 103 healthy controls and 71 symptomatic deployers with asthma and/or distal lung disease completed a questionnaire, spirometry and MBW testing. SAS v. 9.4 was used to compare MBW parameters between deployers and controls via univariate analyses and adjusted for demographic factors using multiple linear regression.

Results

Deployers were significantly more likely than controls to have an abnormal lung clearance index (LCI) score indicating global ventilation inhomogeneity. Adjusting for sex, smoking status, smoking pack-years and body mass index, LCI scores were significantly more abnormal among those with deployment-related asthma and distal lung disease compared to controls. The unadjusted variable Sacin (a marker of ventilation inhomogeneity in the acinar airways) was higher and thus more abnormal in those with both proximal and distal airways disease. Deployers who reported more frequent exposure to explosive blasts had significantly higher LCI scores.

Conclusions

This study demonstrates the utility of MBW in evaluating exposure-related airways disease in symptomatic military personnel following deployment to austere environments, and is the first to link exposure to explosive blasts to measurable small airways injury.

Reference

Zell-Baran, L.M., Krefft, S.D., Moore, C.M., Wolff, J., Meehan, R. & Rose, C.S. (2020) Multiple breath washout: A noninvasive tool for identifying lung disease in symptomatic military deployers. Respiratory Medicine. doi: 10.1016/j.rmed.2020.106281. Online ahead of print.

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