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Etiologies of Bronchiectasis in an Active Duty Military Population
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A6273 - Etiologies of Bronchiectasis in an Active Duty Military Population
Author Block: I. McInnis1, E. T. Mccann2, B. Barber1, M. J. Morris3; 1MCHE-ZDM-P/Pulmonary/Critical Care Medicine, Brooke Army Medical Center, JBSA – Fort Sam Houston, TX, United States, 2Pulmonary and Critical Care Medicine, San Antonio Military Medical Center (SAMMC), San Antonio, TX, United States, 3Brooke Army Medical Ctr, San Antonio, TX, United States.
Rationale: Bronchiectasis is an uncommon disorder in adults and has increasing frequency with age. Sixty-three percent of the childhood subjects in a Cochrane review had an underlying disorder to include infectious (17%), immunodeficiency (16%), aspiration (10%), and ciliary dyskinesia (9%). The etiology for bronchiectasis in a healthy military population has not been previously described in relationship to deployment and potential airway exposures.
Methods: A retrospective chart review was conducted using the electronic medical record for active duty service members with a diagnosis of bronchiectasis. Basic demographic data, pulmonary function testing and chest imaging were reviewed. Additionally, evaluation for the etiology of bronchiectasis to include bronchoscopy, culture data and laboratory data for underlying rheumatologic and immune disorders. Particular note was made for deployment history to determine if potential exposures during Southwest Asia were related to disease onset.
Results: Initial review of medical records identified 365 individuals with a diagnosis of bronchiectasis. The cohort was 84.4% male with a mean age of 40.3 ± 14.3 years. CT imaging was performed in 90% of patients while PFTs were done in 79%. Notably, 213 (58.4%) individuals were under the age of 40 while the remaining 152 (41.6%) over 40 years old. In those patients with full PFTs (n=58), mean FEV1 (80.3% vs. 76.1%), FEV1/FVC (74.4% vs. 70.6%), TLC (93.7% vs. 87.6%) were higher in patients under 40 years. DLCO was significantly higher in under 40 (89.4%) compared to over 40 (72.3%). 28.5% underwent FOB, 15% were tested for cystic fibrosis, nuclear antibody testing in 42%, alpha-1-antitrypsin levels in 35%, immunoglobulins in 43% and bacterial cultures in 45%. No etiology was determined in 45% of patients, prior infection in 26%, and various other etiologies to include 1 patient with alpha-1 antitrypsin, 7 with cystic fibrosis, 10 with immune deficiency, 4 with ABPA, and 3 patients with congenital airway abnormalities.
Conclusions: Despite exclusion of patients with existing bronchiectasis for military service, a significant percentage of personnel have been diagnosed with this disorder. This population of individuals should be routinely evaluated for underlying disorders to include cystic fibrosis, rheumatologic and immunologic disorders. Relationship to viral pulmonary infections or exposures to include deployment should be established.
Author Block: I. McInnis1, E. T. Mccann2, B. Barber1, M. J. Morris3; 1MCHE-ZDM-P/Pulmonary/Critical Care Medicine, Brooke Army Medical Center, JBSA – Fort Sam Houston, TX, United States, 2Pulmonary and Critical Care Medicine, San Antonio Military Medical Center (SAMMC), San Antonio, TX, United States, 3Brooke Army Medical Ctr, San Antonio, TX, United States.
Rationale: Bronchiectasis is an uncommon disorder in adults and has increasing frequency with age. Sixty-three percent of the childhood subjects in a Cochrane review had an underlying disorder to include infectious (17%), immunodeficiency (16%), aspiration (10%), and ciliary dyskinesia (9%). The etiology for bronchiectasis in a healthy military population has not been previously described in relationship to deployment and potential airway exposures.
Methods: A retrospective chart review was conducted using the electronic medical record for active duty service members with a diagnosis of bronchiectasis. Basic demographic data, pulmonary function testing and chest imaging were reviewed. Additionally, evaluation for the etiology of bronchiectasis to include bronchoscopy, culture data and laboratory data for underlying rheumatologic and immune disorders. Particular note was made for deployment history to determine if potential exposures during Southwest Asia were related to disease onset.
Results: Initial review of medical records identified 365 individuals with a diagnosis of bronchiectasis. The cohort was 84.4% male with a mean age of 40.3 ± 14.3 years. CT imaging was performed in 90% of patients while PFTs were done in 79%. Notably, 213 (58.4%) individuals were under the age of 40 while the remaining 152 (41.6%) over 40 years old. In those patients with full PFTs (n=58), mean FEV1 (80.3% vs. 76.1%), FEV1/FVC (74.4% vs. 70.6%), TLC (93.7% vs. 87.6%) were higher in patients under 40 years. DLCO was significantly higher in under 40 (89.4%) compared to over 40 (72.3%). 28.5% underwent FOB, 15% were tested for cystic fibrosis, nuclear antibody testing in 42%, alpha-1-antitrypsin levels in 35%, immunoglobulins in 43% and bacterial cultures in 45%. No etiology was determined in 45% of patients, prior infection in 26%, and various other etiologies to include 1 patient with alpha-1 antitrypsin, 7 with cystic fibrosis, 10 with immune deficiency, 4 with ABPA, and 3 patients with congenital airway abnormalities.
Conclusions: Despite exclusion of patients with existing bronchiectasis for military service, a significant percentage of personnel have been diagnosed with this disorder. This population of individuals should be routinely evaluated for underlying disorders to include cystic fibrosis, rheumatologic and immunologic disorders. Relationship to viral pulmonary infections or exposures to include deployment should be established.
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