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Key findings

Study finds uptick in lung disease in recent Veterans

May 23, 2016

A U.S. Army soldier braves a cloud of dust near the Iraq-Iran border in 2009. A new study found an increase in chronic lung disease between 2003 and 2011 among VA patients who served in Iraq or Afghanistan. <em>(DoD photo)</em>
A U.S. Army soldier braves a cloud of dust near the Iraq-Iran border in 2009. A new study found an increase in chronic lung disease between 2003 and 2011 among VA patients who served in Iraq or Afghanistan. (DoD photo)

A U.S. Army soldier braves a cloud of dust near the Iraq-Iran border in 2009. A new study found an increase in chronic lung disease between 2003 and 2011 among VA patients who served in Iraq or Afghanistan. (DoD photo)

Among VA patients who served in Iraq and Afghanistan, the prevalence of asthma nearly tripled between 2003 and 2011, from 1.1 percent to 3.1 percent.

The rate of chronic obstructive pulmonary disease (COPD) also increased, though not as sharply— from 0.31 percent to 0.55 percent.

Those are two of the findings from a study on chronic lung disease among the more than 760,000 Veterans who served in Iraq or Afghanistan and received VA health care during the study period.

The study appeared in the May 2016 issue of Military Medicine.

The authors, led by a team at the South Texas Veterans Health Care System, say the findings "may suggest a link between deployment exposures and increased diagnoses of chronic lung disease in [Iraq and Afghanistan Veterans]."

"Smoking will only exacerbate deployment-related respiratory problems."

Mixed findings in past research

The new results add to other studies by VA and other institutions suggesting that recent deployments may have contributed to new lung disease. But the exact causes aren't clear.

Experts recognize burn pits, sand and dust storms, and other environmental hazards of the Mideast war zones as possible contributing factors. But relatively high rates of cigarette smoking among troops and Veterans also appear to play a significant role.

And in fact, some research that used rigorous clinical testing—such as lung function tests—did not find differences between deployed and non-deployed troops. The question continues to be studied.

Importantly, the new study did not compare rates of lung disease between deployed and non-deployed Veterans. It only identified a rise in the percentage of Iraq and Afghanistan Veterans in the VA system who sought care for respiratory ailments.

In an interview, lead author Dr. Mary Jo Pugh said it's possible that the trend seen in the study has something to do simply with the aging of the Iraq-Afghanistan cohort, even if the study looked only at a time span of less than a decade.

"What we need to do is develop a longitudinal cohort that includes individuals who served in different periods of the wars, to begin disentangling the effect of deployment-related exposures, aging, and the interactions between exposures and aging," says Pugh. She says efforts are underway with collaborators from the Department of Defense to move this research forward.

Pugh is with VA and the University of Texas Health Science Center at San Antonio.

COPD includes chronic bronchitis or emphysema, or a combination of both. In addition to COPD and asthma, the study also looked at interstitial lung disease. The term includes several conditions that all involve scarring of the lung. This diagnosis also became more widespread, from 0.13 percent in 2003 to 0.28 percent in 2011.

But whereas the other two conditions rose in prevalence fairly steadily from year to year, interstitial lung disease showed a less predictable pattern. For example, it dropped in prevalence between 2005 and 2006, and then again between 2009 and 2010.

Overall, 4.5 percent had diagnosis

All in all, around 34,000 out of the total study population of more than 760,000 Veterans—4.5 percent—had any of the chronic lung diseases included in the analysis. Over the entire study period, 0.8 percent were diagnosed with COPD, 3.4 percent with asthma, and 0.3 percent with interstitial lung disease.

Not surprisingly, the researchers found that those who appeared to be tobacco users—based on records showing a related diagnosis, or receipt of smoking cessation services—had more than a fourfold risk of lung disease.

Older age and a traumatic brain injury were also linked to a higher risk.

The TBI finding makes sense, say the researchers, because blasts associated with TBI might also affect the respiratory system. By the same token, Veterans who suffered TBIs were more likely to be in forward operating areas and potentially had more environmental exposures.

Somewhat surprisingly, though, multiple deployments were not linked to greater odds of lung disease. The researchers say the study did not gather detailed data on deployments that might help explain the finding.

Message to Vets: Get tested early

Pugh says one follow-up study planned by her team will "examine the extent to which individuals who have chronic respiratory conditions receive adequate screening—such as pulmonary function tests—and treatment. There is concern among clinicians that many of these Veterans are seen in clinic for respiratory symptoms [but do not receive] pulmonary function tests," and therefore diagnosis and treatment can be delayed.

The take-home message for Veterans, she says, is that anyone who has been deployed and has complained of respiratory symptoms should receive an evaluation, to include chest imaging and pulmonary function testing, as early as possible. This will help ensure appropriate treatment and boost the odds of good outcomes.

And if anyone needs another reason to quit smoking, this might be it. Says Pugh, "Smoking will only exacerbate deployment-related respiratory problems."

Pugh worked on the study with colleagues from other VA sites, the Uniformed Services University of the Health Sciences, Brooke Army Medical Center, and the University of Milan in Italy. VA funded the study.

For more information on burn pits and other environmental hazards that might affect Veterans' lung health, visit www.publichealth.va.gov. To learn more about VA research on respiratory conditions, go to www.research.va.gov/topics.


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