Research Seeks Answers to Baffling Warfighters’ Respiratory Disease

When Army Staff Sgt. Adam DeVore returned home after serving four years and four months in Iraq, he faced a new battle. “I couldn’t breathe. I felt like I was suffocating,” he said.

DeVore’s resting pulmonary function tests showed no abnormalities, and numerous doctors told him his lungs were fine. “It’s frustrating,” said DeVore. “You know your own body. You know when something’s wrong.”

DeVore is not alone. Warfighters returning from service in Iraq and Afghanistan suffer elevated rates of respiratory disease, ranging from mild asthma to life-threatening bronchiolitis obliterans. Many seem fine on standard pulmonary function tests, but cannot complete physical tests to maintain their active status.

Army Staff Sgt. Adam DeVore is able to maintain his active status thanks to pulmonologist Cecile Rose, MD, MPH, who found the cause of his breathing problems.

In 2010, Pulmonologist Cecile Rose, MD, MPH, and Rheumatologist Richard Meehan, MD, a veteran of the Iraq and Gulf wars himself, began seeing warfighters with lung disease at the Center of Excellence on Deployment-Related Lung Disease — the only center of its kind in the country. With cardiopulmonary exercise tests, high-resolution chest CT scans and lung biopsy, physicians diagnosed DeVore with constrictive bronchiolitis and related conditions that basic lung tests had missed.

After experiencing “a lack of compassion” from many doctors, DeVore immediately noticed a difference when he came to National Jewish Health. “At National Jewish Health, there’s a much different feel. They’re actually looking into it to try and find the answer,” he said.

There are many more questions than answers surrounding warfighters’ lung diseases, which research hopes to address. “Warfighters deployed to Southwest Asia suffer a baffling array of lung diseases at almost twice the rate of veterans deployed elsewhere,” said Greg Downey, MD, executive vice president of Academic Affairs at National Jewish Health. His research lab investigates lung injury and repair. In 2016, Dr. Downey and a multidisciplinary team of his colleagues were awarded $11.5 million by the Department of Defense for research to find the answers warfighters need. The grants take advantage of the unique cohort of previously deployed veterans seen by Dr. Rose and others at National Jewish Health, and leverage the institution’s expertise in lung disease and repair.

This grant will explore the “two-hit hypothesis,” which suggests that chronic exposure to desert dust and other particulate matter predisposes the respiratory tissue to enhanced injury when hit by a second harmful stimulus, such as toxic chemicals, cigarette smoke, allergens or viral infections. The researchers will also evaluate an experimental medication that targets a pathway involved in the repair of injured cells in the lung.

“The history National Jewish Health has of research and moving things in a positive direction for a cure gave me peace of mind,” said DeVore, who is participating in the research. “National Jewish Health is my best hope.”