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VA research on

Respiratory Health


Introduction

According to the U.S Environmental Protection Agency, the average person takes between around 17,000 to 23,000 breaths a day. For a healthy person, this is a simple process. But for millions of people with respiratory problems, breathing is not easy.

Two examples of respiratory diseases that can restrict breathing are asthma and chronic obstructive pulmonary disease (COPD). Asthma is a chronic inflammatory disease in which the airways narrow and may become filled with excess mucus, making it hard to breathe. While it cannot be cured, the symptoms can be controlled.

COPD is a group of diseases that limit airflow and make it hard to breathe. It is usually progressive and is associated with an abnormal inflammatory response in the lungs to noxious particles or gases, like cigarette smoke.

COPD most commonly includes two conditions: emphysema (in which the air sacs of the lungs are damaged and enlarged) and chronic bronchitis (a long-lasting cough caused by chronic inflammation of the bronchial tubes). Most people with COPD have both conditions.

Veterans may suffer from other respiratory problems through exposure to infectious agents or airborne environmental hazards. Examples of respiratory diseases that may be caused by infectious agents are tuberculosis, lung cancer, and pneumonia.

Many Veterans were exposed to airborne environmental hazards during military service, such as Agent Orange, burn pits, sandstorms, or fumes from aircraft exhaust.

Veterans who develop respiratory cancer (cancer of the lung, throat, or windpipe) and were exposed to Agent Orange or other herbicides during military service may be eligible to receive VA health care and disability compensation.

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Selected Major Accomplishments

  • 1946:Developed and tested effective therapies for tuberculosis through multicenter clinical trials that led to the development of the VA Cooperative Studies Program
  • 1950:Concluded there is "strong circumstantial evidence" linking cigarette smoking with respiratory tract cancers
  • 2013: Foundthat sleep apnea and poor sleep quality predicted diabetes, independent of other diabetes risk factors or mental health status
  • 2014:Learned that treatment for pneumonia that included the antibiotic azithromycin (Zithromax) was associated with a significantly lower risk of death and a slightly increased risk of heart attack
  • 2016: Developed a blood testto determine the causes of upper respiratory illness, to help ensure antibiotics are used appropriately
  • 2019: Learned that artificial intelligence techniques can improve the ability to diagnose lung cancer
  • 2020: Found that wearing face masks to prevent infection does not increase the amount of carbon dioxide in the bloodstream

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New, Ongoing, and Published Research

VA research on respiratory health covers a wide range of topics, including tuberculosis, lung cancer and smoking, influenza, and pneumonia. Featured respiratory research includes sleep apnea, chronic obstructive pulmonary disease, and respiratory infections. VA research has also focused on the COVID-19 pandemic that began in 2019 and 2020.

VA researchers are advancing the understanding, prevention, and treatment of numerous respiratory illnesses, ranging from the common cold and pneumonia to major public health threats such as tuberculosis and lung cancer. The department's Office of Public Health (OPH) works with all levels of government to prepare for possible pandemic influenza (flu) outbreaks. OPH researchers are also actively studying airborne hazards like burn pits and other military environmental exposures that may affect respiratory health.

The War Related Illness and Injury Study Center (WRIISC) is a national program dedicated to Veterans’ post-deployment health concerns and unique health care needs. Through the Airborne Hazards and Burn Pits Center of Excellence, WRIISC conducts clinical and translational research related to airborne hazards and burn pits focusing on a range of health concerns, including respiratory problems and unexplained shortness of breath (dyspnea).

Respiratory problems are the leading cause of death in Veterans and others who have spinal cord injury (SCI). VA's Center of Excellence on the Medical Consequences of Spinal Cord Injury, located in New York, is studying ways to treat complications of SCI, including those that affect breathing.

If you are interested in learning about joining a VA-sponsored clinical trial, visit our research study information page.

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➤ Tuberculosis

The VA research program began in 1925, just four years after the Department of Veterans Affairs was established. The organization was then called the Veterans Bureau. Forty percent of VA's first patients had tuberculosis (TB), a contagious bacterial infection that involves the lungs and may spread to other organs. The first head of VA research was a TB specialist. In the 1920s and 1930s, VA researchers published a number of scientific articles on the subject.

After World War II, VA and the Department of Defense conducted a major study to test the effectiveness of the antibiotic streptomycin to treat TB. While initial results were very favorable, researchers soon learned that the antibiotic could cause inner ear damage, and that many patients developed resistance to the drug.

In 1947, VA researchers determined in a follow-up study that a lower dose of streptomycin could achieve favorable results with fewer side effects and less risk of drug resistance. These studies, conducted at a number of VA facilities, were part of VA's first-ever large-scale clinical trial. They eventually led (in 1972) to the development of VA's Cooperative Studies Program, which plans and conducts large multicenter clinical trials and epidemiological studies for VA.

Although TB rates in the United States have fallen to all-time lows, largely thanks to antibiotics, up to 13 million people in the United States are estimated to be infected with a latent case of TB. Of this number, 5% to 10% of people will become sick with the disease if they are not treated, according to the Centers for Disease Control and Prevention.

More effective treatment—In 2016, researchers with the VA Tennessee Valley Health Care System and Vanderbilt University found that a small chemical change to fluoroquinolone, an antibacterial drug used to treat TB, results in a compound that is more effective against tuberculosis enzymes.

The new compound, a modified version of the drug moxifloxacin, also maintains its activity against drug-resistance forms of the enzyme, and could lead to a more effective treatment for TB.

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➤ Lung cancer

Early associations of lung cancer to smoking—In 1932, the Edward Hines, Jr. VA hospital in Illinois established a Tumor Research Laboratory to complement the work of its cancer treatment center—VA's first laboratory to receive funds specifically for research work. The laboratory's first success came through the work of Dr. Robert Schrek, who pioneered studies on the effects of cigarette smoking on cancers of the lung and throat.

Schrek's work was followed up by the work of Dr. Oscar Auerbach, of VA's East Orange hospital, now the East Orange campus of the VA New Jersey Health Care System. Auerbach's landmark animal research study found that cigarette smoke caused major changes in the lungs of animals.

Auerbach was later a participant in the first Surgeon General's report, published in 1964, which explained the harmful effects of smoking to America and the world.

Artificial intelligence diagnoses lung cancer—A team of researchers with the Palo Alto VA Medical Center, Google, Northwestern University, and New York University found that artificial intelligence computer programs can diagnose lung cancer better than physicians who specialize in the disease.

The 2019 study used computer software to review nearly 8,000 computed tomography (CT) scans and compared the results with readings by six lung cancer specialists. The computer accurately detected cancer in 5% more cases than the specialists, and reduced false positives by 11%.

The research team hopes that artificial intelligence can one day help clinicians detect lung cancer earlier and reduce the number of false positive findings.

Risks of e-cigarettes—In 2015, a team of researchers at the VA San Diego Healthcare System in California looked at the possible health risks of e-cigarettes. They found e-cigarettes damaged respiratory cells in ways that could lead to cancer. The damage occurred even with nicotine-free versions of the products. The experiments also showed that the e-cigarette vapor was not as harmful to respiratory cells as regular cigarette smoke.

The team concluded that further research is needed to better understand the long-term health effects of e-cigarettes in humans.

A 2016 study by a different team of researchers in San Diego reported that e-cigarettes can kill human airway cells. At high doses, they also suppress users' immune defenses, inflame the lungs, and promote the growth of bacteria in the lungs that can cause pneumonia and other diseases.

The team found these issues in the airways and blood of mice that inhaled e-cigarettes for one hour a day, five days a week, for four weeks. According to team member Dr. Laura Crotty Alexander, the study demonstrates that the vapor from e-cigarettes is not benign. She described the findings as "frightening" for those who use the products.

Genomics and lung cancer—In 2015, VA's New England Healthcare System and the Massachusetts Veterans Epidemiology Research and Information Center instituted a clinical program to help Veterans who have been newly diagnosed with non-small cell lung cancer. With Veterans' permission, physicians collect specimens of their tumors and send them to qualified laboratories for targeted genomic sequencing—a process that determines the DNA sequence of genes that are considered important in lung cancer.

The sequencing identifies specific mutations that cause lung cancer to grow. Physicians can then treat Veterans with specific drugs that are targeted to their mutations. Veterans can also take part in clinical trials designed to test new drugs targeted toward their specific cancer mutations.

The program is now part of VA’s national Precision Oncology Program, part of VA’s National Oncology program. The program, which includes a research component, grew out of the lung cancer program. Patients can agree to have their clinical, genetic, and imaging data shared with researchers to help advance cancer care. All research samples are coded and contain no personally identifiable information.

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➤ Smoking cessation

Development of the nicotine patch—In 1984, VA research developed the nicotine transdermal patch, helping Veterans and others to quit smoking. The patch was developed by Dr. Jed Rose, Dr. Daniel Rose, and Dr. Murray Jarvik. The patch transfers nicotine into the bloodstream to reduce cravings for the substance.

Successful counseling method—In 2016, a team led by researchers from the VA New York Harbor Healthcare System and the New York University School of Medicine found that specialized counseling delivered by telephone may be more effective than smoking cessation quit-line counseling to help smokers with mental health issues to kick the habit.

The study looked at 522 Veterans with mental health issues, 270 of whom received specialized counseling that incorporated motivational interviewing, problem-solving therapy, and cognitive behavioral therapy. The other 307 Veterans were referred to their local quit lines.

The team found that the specialized counseling yielded a quit rate of 26% at six months, versus 18% for the state quit lines.

Varenicline and bupropion do not appear to increase neuropsychiatric risk—Varenicline (sold as Chantix) and bupropion (sold as Wellbutrin and Zyban) are prescription medications used to treat nicotine addiction.

A 2016 study by VA researchers in Hines, Illinois, Bedford, Massachusetts, and Pittsburgh, along with researchers from the U.S. Food and Drug Administration and two universities, found that these medications do not appear to increase the incidence of serious neuropsychiatric illnesses such as depression, schizophrenia, or bipolar disorder, when compared with placebo.

More than 8,000 adults aged 18 to 75, who smoked more than 10 cigarettes a day and were motivated to stop smoking, participated in the study. About half (4,116) had a history of a past or current stable psychiatric condition. For 9 to 12 weeks, some participants received varenicline, some bupropion, some a nicotine patch, and others a placebo.

The participants were assessed to see whether they had any moderate to severe neuropsychiatric events during their treatment, and at a follow-up visit 9 to 24 weeks after the treatment ended. These events included agitation, aggression, panic, anxiety, and suicidal ideation.

While there were more adverse events reported in the group that previously had psychiatric disorders, there was no significant increase in the incidence of such events in the groups receiving any of the four kinds of treatment.

Varenicline was more effective in helping people stop smoking than bupropion, nicotine patches, or placebo. Bupropion was about as effective as nicotine patches, and both were more effective than placebo.

Lung cancer screening issues—A 2015 study by researchers with the VA Puget Sound Health Care System and the University of Seattle found that lung cancer screening can lower smokers' motivation to quit smoking.

The team studied 37 current smokers offered lung cancer screening by their primary care physician during 2014. After the screening, the smokers were interviewed by the research team. The team found nearly half of those interviewed found some reason to believe that just being screened meant that they did not need to stop smoking.

Some told the researchers that undergoing the test had the same benefit as stopping smoking, even when precancerous lung nodules were found. Others felt that being able to return for additional screenings would protect them, and still others felt that a cancer-free screening test indicated that they were among the lucky ones who would avoid the harms of smoking.

All of these assumptions are false—as is the assumption many study participants had that lung cancer was the only potentially lethal effect of smoking. The team suggested that counseling for smokers should target these and other justifications that some people use to avoid quitting.

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➤ COVID-19

In 2019, a new type of coronavirus, SARS-CoV-2, emerged—creating a global pandemic. The disease it causes, COVID-19, can produce mild-to-severe respiratory illness and even death. Symptoms can include fever, cough, shortness of breath, fatigue, body aches, and loss of taste or smell. VA has implemented a swift public health response to protect and care for Veterans and staff in the face of this urgent health threat.

Among the steps VA has taken to prevent COVID-19 transmission are targeted research programs, community outreach to Veterans, screening at VA health care facilities, a phased vaccination rollout, and protocols to protect patients admitted to community living centers.

To find out about VA research on the new coronavirus, visit the COVID-19 topic page to learn about clinical trials, data analyses, and research partnerships that are taking place to find ways to prevent and treat COVID-19.

Face masks do not cause carbon dioxide poisoning—During the COVID-19 pandemic, some individuals suggested that wearing face masks could cause health risks, especially for people with chronic obstructive pulmonary disease (COPD), a group of diseases that cause breathing problems.

In 2020, researchers at the Miami VA Healthcare System and the University of Miami studied 30 people, 15 with lung conditions and 15 without, to determine whether wearing a surgical face mask would change levels of oxygen and carbon dioxide saturation in the blood. For both groups they found there were no significant changes in oxygen and carbon dioxide measurements after a walking test, even in subjects with severe lung impairments.

Accordingly, the team concluded that surgical masks do not affect gas exchange under routine circumstances. The discomfort associated with face mask use, they wrote, should not lead to unsubstantiated safety concerns, because face masks are an important way to reduce the risk of COVID-19 infection, along with hand washing and social distancing.

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➤ Influenza

Influenza, or the flu, is a contagious respiratory illness caused by viruses that infect the nose, throat, and lungs. It can cause mild to severe illness, and at times can lead to death. Experts say the best way to prevent the flu is by getting a flu vaccine each year.

According to VA's Office of Public Health, flu shots are both safe and effective. Most people have no serious side effects or allergic reactions. A very small number of people may get minor body aches, headache, or a low-grade fever that lasts a day or two. People cannot catch the flu from a flu shot, because it only contains strains of inactivated flu viruses.

Other things people can do to slow the spread of flu include avoiding contact with people who are sick, washing their hands often, keeping their hands away from their face, covering coughs and sneezes, and staying home when they are sick.

Flu vaccines for the elderly—In 2015, researchers at the Philadelphia VA Medical Center and the University of Pennsylvania attempted to determine whether the standard dose version of flu vaccine or a higher dose were better for Americans over 65.

The study, which looked at more than 165,000 VA patients, found that for those between the ages of 65 and 84, the standard dose worked just as well. However, for Veterans 85 or older, the higher dose was better in terms of avoiding hospitalization for the flu or pneumonia.

Determining flu outbreaks—Another 2015 study, by researchers with VA and other health care institutions throughout the nation, described a new algorithm to help hospitals and public health officials determine the earliest stages of flu season. Having this information could help preserve resources while combatting the virus.

The algorithm, which researchers call the Above Local Elevated Respiratory Illness Threshold (ALERT), uses routine information, such as the number of flu cases confirmed per week in a region, to determine where and when the flu needs to be combated.

The tool takes a region's flu history into account and allows users to identify the number of cases per week they believe would signal the start of the season in their area. It also identifies the length of time influenza outbreaks are likely to last.

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➤ Pneumonia

Pneumonia refers to infection that inflames the air sacs of the lungs. It can be caused by a variety of bacteria, viruses, and fungi. Pneumonia is common among older Americans and sends hundreds of thousands of seniors to the hospital each year.

Tooth brushing prevents pneumonia—In hospital and community living centers, good oral hygiene can prevent harmful bacteria from being inhaled into patients’ lungs, which can cause pneumonia. According to a 2018 study led by researchers at the Salem VA Medical Center in Virginia, brushing twice a day to remove the biofilm that accumulates around teeth reduced the number of monthly cases of pneumonia at the Community Living Center (CLC) from four to zero.

Salem’s work to reduce pneumonia by providing CLC patients with effective oral care has been replicated in eight other VA hospitals. The VA health care system is in the process of adopting the innovation nationwide.

Drug for severe pneumonia—Tocilizumab (TCZ) is a drug often used to treat rheumatoid arthritis. It is the focus of an ongoing clinical trial focused on COVID-19 patients with severe pneumonia. VA hospitals in Houston and Miami are among nearly 70 medical sites worldwide participating in the international study.

TCZ is in a class of drugs that reduce the strength of the body’s immune system. TCZ has the potential to block interleukin-6, a chemical that plays a key role in the body’s immune response and is involved in the development of many diseases.

All study participants were newly hospitalized with pneumonia. They were monitored for 28 days for their response to TCZ, including disease progression, length of hospitalization, and the need for critical care and other supportive treatment. The study's primary outcome is the number of participants who require mechanical ventilation by day 28.

The researchers hope TCZ can prevent the abnormal inflammatory response in COVID-19 pneumonia that leads to respiratory failure.

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➤ Airborne environmental exposures

Respiratory health has become a major concern for many of the 2.77 million service members who have served in Iraq and Afghanistan since 9/11. Many Veterans who served in these countries have developed respiratory problems possibly connected to their service. One reason may be burn pits—large, open areas in which military units burned trash ranging from human waste to compact discs and plastics.

Additional reasons for respiratory problems in this group of Veterans can include other airborne hazards like sand and dust storms and general air quality. Many Veterans also smoked while in service.

Breathing problems in Iraq and Afghanistan Veterans—In a 2020 study, researchers with the War Related Illness and Injury Study Center (WRIISC) located at the VA New Jersey Health Care System and the New Jersey Medical School at Rutgers University tested the breathing of 24 Iraq and Afghanistan Veterans without asthma who were not seeking treatment for breathing problems. They found the rate of exercise-induced bronchoconstriction (EIB)—narrowing of the airways in the lungs—in that group was 17%, similar to that in the general population.

However, the study noted that an additional 42% of participants had a probable constriction response that did not meet the full diagnostic criteria for EIB. This group reported persistent coughing, wheezing, and shortness of breath at the time they were tested.

The research team urged that respiratory symptoms continue to be monitored in this population.

Mental health and respiratory problems—Veterans who served in Afghanistan and Iraq and had a mental health diagnosis are more likely to have respiratory problems, according to a 2018 study by researchers at VA Portland Health Care System and the Oregon Health and Science University.

The researchers looked at data for more than 180,000 Veterans, and found that 14% had a respiratory condition such as bronchitis, asthma, or COPD. Of that group, 77% also had a diagnosis of a mental health condition. According to the team, the results show the importance of care coordination for Veterans with multiple conditions.

Link between blast exposure and respiratory issues—A possible link between blast exposure during military service and difficulty breathing or decreased exercise stamina has been uncovered by researchers at the WRIISC at the VA New Jersey Health Care System.

The team looked at the records of 43,000 Veterans enrolled in VA’s Airborne Hazards and Open Burn Pit registry. The registry aims to facilitate research into the effects of hazardous airborne exposures and is open to Iraq and Afghanistan Veterans. In an analysis published in 2017, researchers reported that being exposed to explosion blast waves led to self-reported breathing difficulties several years after exposure. Such problems appear to be unique to Veterans at this time. The team hopes that this possible link will be explored further in order to confirm the study’s findings.

Dust mites may trigger asthma—Dust mites are tiny spider-like creatures that can trigger allergic reactions like runny noses, itchy or watery eyes, and sneezing. Researchers at the VA Maryland Health Care System are looking at how dust mites affect the immune system and set off respiratory problems in humans. Previous research, including a 2011 study, has suggested that dust mites can be one of several possible triggers that may explain new-onset asthma among Iraq and Afghanistan Veterans.

The research team is comparing lab-grown house dust mites with environmental dust samples collected from Camp Victory in Iraq and from Fort Irwin, California, a military installation with a similar climate to Iraq. They hope to see how these substances affect immune cells isolated from mice or human blood samples. They are also looking to see how the lungs of laboratory mice respond when exposed to dust and specifically to mites, to shed further light on how humans are affected.

Finally, the team is testing the hypothesis that Iraq and Afghanistan Veterans have been exposed to a much higher level of inhaled particulates, which may explain higher rates of asthma and other respiratory problems in this group. Researchers hope their work will add to the body of knowledge on the causes of respiratory symptoms in these Veterans.

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➤ Sleep apnea

Sleep apnea (pauses in breathing that occur at night) can cause excessive daytime sleepiness, trouble concentrating, high blood pressure, cardiac and pulmonary disease, and motor vehicle accidents.

Relationship with PTSD—In 2016, researchers at the VA San Diego Healthcare System and the University of California found that the risk of obstructive sleep apnea among Iraq and Afghanistan Veterans increased with the severity of their PTSD symptoms.

The investigators looked at 195 Iraq and Afghanistan Veterans—more than 93% were men—who had visited a VA outpatient PTSD clinic for evaluation of their symptoms. Using clinical questionnaires to evaluate both levels of PTSD and sleep apnea risk, researchers found that nearly 70% of Veterans in the study were at high risk for developing sleep apnea, and that the risk increased with the severity of their PTSD symptoms. This was despite the fact that many of them did not have a high body mass index or high blood pressure, considered risk factors for sleep apnea.

Weight loss and sleep apnea—In a 2014 study related to sleep breathing problems, researchers at the Corporal Michael J. Crescenz VA Medical Center in Philadelphia and the University of Pennsylvania found that losing weight does far more to reduce cardiovascular risk factors in people with sleep apnea, which is strongly linked to obesity, than a therapy called continuous positive airway pressure (CPAP).

Of the 181 Veterans in the study, each of whom were both obese and had moderate to severe sleep apnea, some were treated with CPAP therapy, others received weight loss therapy, and a third group received both CPAP and weight loss help. Researchers found that, while CPAP therapy was helpful in reducing high blood pressure, weight loss was the most important factor in improving cardiovascular health in patients with sleep apnea. They also found that weight loss and CPAP therapy together resulted in larger reductions in blood pressure than either therapy alone.

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➤ Chronic obstructive pulmonary disease

To help Veterans suffering from lung diseases like COPD, VA is funding research into the development of a 3D-printed artificial lung. The research, led by a team at the VA Ann Arbor Health Care System in Michigan, has a goal of building the first wearable artificial lung that is both compatible with living tissue and capable of supporting breathing.

Researchers see the artificial lung as a temporary measure to help patients waiting for lung transplants, or to aid breathing in those whose lungs are healing. According to the team, future versions could have longer-term applications. The research is focused on patients with end-stage COPD, chronic coughing, lung infections, or respiratory failure. Removal of carbon dioxide in the blood is a critical need for many Veterans with COPD, and the artificial lung will be designed to help in that process.

In addition to COPD, the 3D lung could be used as a temporary measure for people with diseases such as acute respiratory distress syndrome, a life-threatening injury that allows fluid to leak into the lungs, impairing breathing.

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➤ Lung function and HIV

In a 2020 study of 1,100 men, researchers with the Minneapolis VA Health Care System and other academic institutions found that HIV-positive men were more likely to have abnormal lung functioning, based on low diffusing capacity in their lungs.

Diffusing capacity measures the ability of the lungs to transfer oxygen into red blood cells. Low diffusing capacity has been linked to poorer quality of life, lower exercise capacity, and a higher risk of respiratory disease.

The researchers indicated that the reasons for differences in diffusing capacities were unclear, but said there appears to be a complex relationship between lung function abnormalities, HIV infection, HIV treatment, cigarette smoking, and immune function.

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➤ Upper respiratory infections

An acute upper respiratory infection (URI) is a contagious infection that involves the nose, throat, and lungs. The common cold is the most well-known URI, but other types include sinusitis, pharyngitis, epiglottitis, and tracheobronchitis.

Both viruses and bacteria can cause acute URIs, and the condition is one of the most common reasons for seeking medical care. However, it is difficult to determine whether a URI is viral in nature or is caused by bacteria—potentially leading to inappropriate prescriptions for antibiotics. This is one of the chief reasons that new strains of antibiotic-resistant bacteria are developing.

Scientists with the Durham VA Medical Center and Duke University are developing a blood test that can determine the cause of a URI. In a 2016 study, researchers examined the genetic expression associated with URIs. Using blood samples, they were able to determine with 87% accuracy whether the illness was bacterial, viral, or the result of a noninfectious cause.

Currently, it takes 8 to 10 hours to obtain results from the test. The team is working to shorten the time frame so that the correct treatment can be prescribed while the patient is still at the health care facility.

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More on Our Website

Selected Scientific Articles by Our Researchers

Historical Articles:

Tobacco smoking as an etiologic factor in disease; cancer. Schrek R, Baker LA, et al. VA's first major study linking smoking to cancer. Cancer Res. 1950 Jan; 10(1):49-58.

The effect of direct cigarette smoke inhalation on the respiratory tree of dogs. Auerbach O, Hammond, EC, Kirman D, Garfinkel L, Stout AP. Auerbach's seminal paper on the effects of smoking. Natl Cancer Inst Monogr 1968 Jun;28:65-67

Transdermal administration of nicotine. Rose JE, Jarvik ME, Rose KD. A paper describing the value of the nicotine patch. Drug Alcohol Depend. 1984 May;13(3):209-13

Recent Articles:

Effect of face masks on gas exchange in healthy persons and patients with COPD. Samannan R, Holt G, Calderon-Candelario R, Mirsaeidi M, Campos M. The effects of wearing face masks on gas exchange are minimal at most even in people with very severe lung impairment. Ann Am Thorac Soc. 2021 Mar;18(3):541-544.

Pulmonary vascular resistance and clinical outcomes in patients with pulmonary hypertension: a retrospective cohort study. Maron BA, Brittan EL, Hess E, Waldo SW, Baron AE, Huang S, Goldstein RH, Assad T, Wertheim BM, Alba GA, Leopold JA, Olschewski H, Galie N, Simmoneau G, Kovacs G, Tedford RJ, Humbert M, Choudhary G. Patients with high levels of pulmonary vascular resistance (2.2 Wood units) are at elevated risk of death—a number well below what is currently associated with the disease. Lancet Respir Med. 2020 Sep;8(9):873-874.

Impact of gastroesophageal reflux on longitudinal lung function and quantitative computed tomography in the COPDGene cohort. Baldomero AK, Wendt CH, Petersen A, Gaeckle NT, Han MK, Kunisaki KM; COPDGene investigators. Gastroesophageal reflux disease may accelerate COPD progression. Respir Res. 2020 Aug 3;21(1):203.

Single-cell RNA sequencing reveals profibrotic roles of distinct epithelial and mesenchymal lineages in pulmonary fibrosis. Habermann AC et al. Five unique lung cell types that may drive idiopathic pulmonary fibrosis are identified.  Sci Adv. 2020 Jul 8;6(28):eaba1972.

Lung function in men with and without HIV. Kunisaki KM, Nourale M, Jensen RL, Chang D, D’Souza G, Fitzpatrick ME, McCormack MC, Stosor V, Morris A. HIV-positive men are at increased risk of abnormal gas exchange compared to men without HIV. AIDS. 2020 Jul 1;34(8):1227-1235.

Exercise-induced bronchoconstriction in Iraq and Afghanistan Veterans with deployment-related exposures. Klein-Adams JC, Sotolongo AM, Serrador JM, Ndirangu DS, Falvo MJ. The rate of bronchial constriction after exercise in Iraq and Afghanistan is similar to the prevalence in the general population, but many study participants had a probable constriction response that did not meet the full diagnostic criteria. Mil Med. 2020 Mar 2;185(3-4):e389-e396.

Association of early palliative care use with survival and place of death among patients with advanced lung cancer receiving care in the Veterans Health Administration. Sullivan DR, Chan B, Lapidus JA, Ganzini L, Hansen L, Carney PA, Fromme EK, Marino M, Golden SE, Vranas KC, Slatore CG. Palliative care is associated with a survival benefit among patients with advanced lung cancer and should be considered a complementary approach to disease-modifying therapy. JAMA Oncol. 2019 Sep 19;5(12):1702-1709.

N95 respirators vs. medical masks for preventing influenza among health care personnel: a randomized clinical trial. Radonovich LJ Jr, Simberkoff MS, Bessesen MT, Brown AC, Cummings DAT, Gaydos CA, Los JG, Krosche AE, Gilbert CL, Gorse GJ, Nyquist AC, Reich NG, Rodriguez-Barradas MC, Price CS, Savor Price C, Perl TM; ResPECT investigators. Among outpatient health care personnel, N95 respirators vs medical masks resulted in no significant difference in the incidence of laboratory-confirmed influenza. JAMA. 2019 Sep 3;322(9):824-833.

End-to-end lung cancer screening with three-dimensional deep learning on low-dose chest computed tomography. Ardila D, Kiraly AP, Bharadwaj S, Choi B, Reicher JJ, Peng L, Tse D, Eternadi M, Ye W, Corrado G, Naidich D, Shetty S. Artificial intelligence can outperform radiologists at diagnosing lung cancer. Nat Med. 2019 Jun;25(6):954-961.

Reducing missed oral care opportunities to prevent non-ventilator associated hospital acquired pneumonia at the Department of Veterans Affairs. Munro S, Baker D. The impact of consistently delivered oral care is substantial in terms of Veteran health, quality of life, and well-being in addition to considerable cost avoidance. Appl Nurs Res. 2018 Dec;44:48-53.

Implementation and dissemination of a Department of Veterans Affairs oral care initiative to prevent hospital-acquired pneumonia among nonventilated patients. Munro S, Haile-Mariam A, Greenwell C, Demirci S, Farooqi O, Vasudeva S. Implementation and dissemination of an oral care initiative enhanced the safety and well-being of Veterans at the Salem VA Medical Center by reducing the risk of non-ventilator-associated hospital-acquired pneumonia. Nurs Adm Q. Oct/Dec 2018;42(4):363-372.

Smokers’ inaccurate beliefs about the benefits of lung cancer screening. Heffner JL, Krebs P, Johnson H, Green PA, Klein DE, Feemster LC, Slatore CG. Au DH, Zeliadt SB. Patients are confused about the actual benefits and limitations of lung cancer screenings. Ann Am Thoracic Soc. 2018 Sep;15(9):1110-1113.

Identifying patients for whom lung cancer screening is preference-sensitive: a microsimulation study. Caverly TJ, Cao P, Hayward RA, Meza R. Patient preferences should be considered when deciding to screen low-risk patients for lung cancer. Ann Intern Med. 2018 Jul 3;169(1):1-9.

Respiratory responses to ozone exposure. MOSES (the multicenter ozone study in older subjects). Arjomandi M, Balmes JR, Frampton MW, Bromberg P, Rich DQ, Stark P, Alexis NE, Costantini M, Hollenbeck-Pringle D, Dagincourt N, Hazucha MJ. Exposure to ozone at near ambient levels induced lung function effects, airway injury, and airway inflammation in older healthy adults. Am J Respir Crit Care Med. 2018 May 15;197(10):1319-1327. 

Afghanistan and Iraq war Veterans: mental health diagnoses are associated with respiratory disease diagnoses. Slatore CG, Falvo MJ, Nugent S, Carlson K. Comprehensive plans that include care coordination with mental health professionals and treatments for mental illnesses may be important for many Veterans with respiratory diseases. Mil Med. 2018 May 1;183(5-6):e249-e257.

Pulmonary nodules: a small problem for many, severe distress for some, and how to communicate about it. Slatore CG, Wiener RS. The article suggests how clinicians can provide high-quality communication for patients with pulmonary nodules, a “near-cancer” diagnosis. Chest. 2018 Apr;153(4):1004-1015.

Blast injury and cardiopulmonary symptoms in U.S. Veterans: analysis of a national registry. Jani N, Falvo MJ, Sotolongo A, Osinubi OY, Tseng CL, Rownecki M, Montopoli M, Morley SW, Mitchell V, Helmer DA. There is a possible link between blast exposure during military service and difficult breathing or decreased exercise stamina among Veterans enrolled in VA’s Burn Pit registry. Ann Intern Med. 2017 Nov 21;167(10):753-755.

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Respiratory Health Fact Sheet

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