Ann Arbor PDCEN

At the VA Ann Arbor Medical Center, we are dedicated to supporting Veterans who have concerns about their lung health due to exposure to hazardous materials during their military service. Our mission focuses on providing excellent clinical care, education, and research in this area.

Our Approach

Comprehensive Care: At the Ann Arbor VA, our team of experts in lung health and environmental medicine delivers personalized care to Veterans who have been exposed to hazardous materials during their military service. Through support from the Post-Deployment Cardiopulmonary Evaluation Network (PDCEN), we have expanded our capabilities to include advanced lung function testing techniques, such as Forced Oscillometry and Exhaled Nitric Oxide assessments. These enhancements allow us to provide comprehensive, state-of-the-art respiratory evaluations tailored to meet the unique needs of every Veteran we serve.

Access to Care:To expand access to specialized care for our Veterans, we have established a Post-Deployment Respiratory Health (PDRH) Clinic. This clinic is dedicated to evaluating Veterans who experience respiratory symptoms and have concerns related to military exposures, offering comprehensive assessments, testing, and ongoing follow-up care. Veterans seen in our PDRH Clinic may also be eligible for enrollment in the Post-Deployment Cardiopulmonary Evaluation Network (PDCEN). Our team is committed to guiding each Veteran through every step of the process, ensuring they receive the support and care they deserve.

Education and Advocacy

We continually strive to raise awareness about respiratory issues related to military service: we published an article in the New England Journal of Medicine highlighting a case of constrictive bronchiolitis in a Veteran and the role the Airborne Hazards and Open Burn Pit Center of Excellence played in the diagnosis. Read more here: A Burning Question: New England Journal of Medicine

To promote awareness of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act, we published a Perspective in the Annals of the American Thoracic Society. Read more here: A Sacred Obligation: Meeting the Needs of Veterans with Airborne Hazard Exposures

An editorial published by our site lead, Dr. John Osterholzer, in Annals of the American Thoracic Society highlights the need for continued commitment to clinical and research efforts in this field. Read more here: A "Quest for Answers" in the Emerging Field of Postdeployment Respiratory Health

(A) Quantitative CT analysis using parametric response mapping identifies and quantifies different lung abnormalities including functional small airways disease (fSAD). (B) Increased fSAD (yellow) identified in the CT scan images obtained from a Veteran diagnosed with constrictive bronchiolitis. (C) Unadjusted analysis showing that the percent of fSAD in military personnel with constrictive bronchiolitis (MPCB) is increased 2-fold relative to healthy control subjects (NORM). Davis, et al; Am J Respir Crit Care Med. 2022

Ongoing Research

Our research program actively explores both basic science and clinical studies. Our team has developed two innovative mouse models to investigate how airborne hazards encountered by Veterans during deployment affect lung health. These models have revealed injury patterns in the lungs that closely resemble those observed in Veterans, helping us to better understand the impact of these exposures. To read more about this research, click on the links below.

• Teitz-Tennenbaum S, Marinetti KN, Lahiri S, Siddiqui K, Flory C, Tennenbaum K, Hicks HG, Song B, Ganguly A, Osterholzer JJ. Sulfur dioxide exposure of mice induces peribronchiolar fibrosis-A defining feature of deployment-related constrictive bronchiolitis. PLoS One. 2025 Jan 24;20(1):e0313992. doi: 10.1371/journal.pone.0313992. PMID: 39854594; PMCID: PMC11761160.
• Teitz-Tennenbaum S, Viglianti SP, Jomma A, Palone Q, Andrews H, Selbmann KN, Lahiri S, Subbotina N, Walker N, Perl AT, Lama VN, Sisson TH, Osterholzer JJ. Sustained Club Cell Injury in Mice Induces Histopathologic Features of Deployment-Related Constrictive Bronchiolitis. Am J Pathol. 2022 Mar;192(3):410-425. doi: 10.1016/j.ajpath.2021.11.012. Epub 2021 Dec 23. PMID: 34954211; PMCID: PMC8895425.

Figure 2. Chronic airway inflammation in murine and deployment-related CB. (A-H) Representative images of lung sections (H & E stained) obtained from a CC-DTA mouse (A – D) at protocol d20, and a veteran diagnosed with DRCB (E – H). Note the peribronchiolar mononuclear cell infiltrates (orange braces in B, F) and collections of intraluminal cells with the appearance of foamy macrophages (blue arrows in D, H) present in both specimens. AW; airway. MCI; mononuclear cell infiltrates. Scale bars 100μm (A, C, E, G) and 40μm (B, D, F, H). Teitz-Tennenbaum et al; Am J Pathol. 2022

In a study with the University of Michigan's Radiology Department, we found that Veterans with constrictive bronchiolitis show more significant small airway issues than healthy individuals, as revealed by advanced CT scan analysis. Our investigation into CT scan analysis methods that can detect subtle evidence of respiratory disease is ongoing. To read more about this research, click on the links below.

Figure 1. Biopsy Specimen of the Right Lung.
Hematoxylin and eosin stained section of lung demonstrates constrictive bronchiolitis (CB) characterized by subepithelial fibrosis that widens (arrows) the normally narrow space between the airway epithelium and smooth muscle (200x magnification). Rabin et al; N Engl J Med. 2022

• Davis CW, Lopez CL, Bell AJ, Miller RF, Rabin AS, Murray S, Falvo MJ, Han MK, Galban CJ, Osterholzer JJ. The Severity of Functional Small Airway Disease in Military Personnel with Constrictive Bronchiolitis as Measured by Quantitative Computed Tomography. Am J Respir Crit Care Med. 2022 Sep 15;206(6):786-789. doi: 10.1164/rccm.202201-0153LE. PMID: 35608541; PMCID: PMC12042848.
• Bell, A.J., Masotti, M., Ram, S. et al. Use of quantitative CT chest imaging to derive and assess a radiographic phenotype of deployment-related constrictive bronchiolitis. Respir Res 26, 195 (2025). https://doi.org/10.1186/s12931-025-03269-8

Hear more about our mission and our operations at the Ann Arbor, VA, from our site director, Dr. John Osterholzer, by watching the video below.