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Abnormal Lung Function in Recent Veterans Raises Respiratory Disease Risks

by U.S. Medicine

July 8, 2014

By Brenda L. Mooney

SAN DIEGO ─ Veterans returning from Iraq/Afghanistan and the Gulf War with pulmonary function abnormalities have a significantly greater risk of developing chronic respiratory disease years later, according to a new study presented at the 2014 American Thoracic Society International Conference in San Diego.1

“Previous studies of Gulf War and Iraq/Afghanistan veterans have found persistent respiratory symptoms decades after their deployment but have not always detected clinically significant pulmonary abnormalities,” said lead author Michael Falvo, PhD, a research physiologist at the VA’s War Related Illness and Injury Study Center. “In our study, however, we found evidence of small airway obstruction and other pulmonary abnormalities in many deployed veterans.”

Members of the 165th Combat Sustainment Support Battalion wear bandanas and googles to protect themselves during a dust storm outside of Camp Buehring, Kuwait, in 2008, prior to reaching their final destination at Camp Taji, Iraq. Dust is one of the environmental exposures implicated in increased lung disease in returning veterans. Photo by Sgt. Aaron Leblanc

Members of the 165th Combat Sustainment Support Battalion wear bandanas and googles to protect themselves during a dust storm outside of Camp Buehring, Kuwait, in 2008, prior to reaching their final destination at Camp Taji, Iraq. Dust is one of the environmental exposures implicated in increased lung disease in returning veterans. Photo by Sgt. Aaron Leblanc

Asthma, chronic obstructive pulmonary disease and other respiratory issues can stem from small airway obstruction.

The study was a departure from previous research in both U.S. and Australian 1991 Gulf War veterans which observed no clinically significant pulmonary abnormalities in deployed veterans despite the presence of symptoms that persist even 20 years later.

Increased respiratory symptom reporting up to 10 years post-deployment also has been an issue among Iraq and Afghanistan veterans (IAV), leading researchers to compare patterns of pulmonary function abnormalities in Gulf War and IAV veterans evaluated at a post-deployment tertiary-care clinic in comparison to a previously published population-based sample of Gulf War veterans evaluated 10 years post-deployment.

The earlier study found identical pulmonary function test results among deployed and nondeployed Gulf War veterans.2

“Our findings did not confirm the hypothesis that deployment to the Gulf War in 1990-91 resulted in increased prevalence of clinically significant pulmonary abnormalities 10 years later, wrote the authors led by Joel B. Karlinsky, MD, of the Boston VAMC and Boston University.

For the recently presented retrospective study, researchers tracked 63 Gulf War veterans approximately 20 years post-deployment and 70 Iraq/Afghanistan veterans about 10 years post-deployment. Study subjects were classified as follows: 1) Normal Pulmonary Function (NPF); 2) Non-Reversible Airway Obstruction (NRAO); 3) Reversible Airway Obstruction (RAO); 4) Restrictive Lung Physiology (RLP); and 5) Small Airway Obstruction (SAO). Categories and prediction equations from the Karlinsky study were used for consistency.

With pulmonary function abnormalities assessed using spirometry, the newer study found that small airway obstruction was five times greater — 38% vs. 7% — and the rate of restrictive lung physiology was twice as much — 24% vs. 12% — among Gulf War veterans compared with a reference group from an earlier population-based sample of Gulf War veterans evaluated 10 years post-deployment. In the Iraq/Afghanistan veterans, meanwhile, the rate of small airway obstruction was also five times greater, 31% vs. 7%, but rates of nonreversible airway obstruction were significantly lower in the study groups than in the reference sample.

“Our findings are generally consistent with previous studies demonstrating NPF in the majority of Gulf War and IAV veterans,” according to Falvo’s presentation. “However, veterans evaluated at our post-deployment health clinic approximately 20 (Gulf War) and 10 (IAV) years post-deployment demonstrate unique spirometry patterns.”

He called for confirmation of the spirometry patterns in larger population-based samples, adding that “high rates of SAO in our sample, particularly for younger veterans, warrant further attention as this pattern may indicate a higher risk of progression to chronic respiratory disease.”

If confirmed in larger studies, Falvo explained, the VA could use the patterns to determine which veterans might require earlier intervention.

“Our laboratory is currently engaged in multiple studies, supported by the Department of Veterans Affairs, to better understand mechanisms of respiratory symptoms in deployed veterans,” he added.

What might have caused pulmonary function abnormalities in veterans serving in Iraq and Afghanistan remains a matter of debate. A VA-commissioned report from the Institute of Medicine in late 2011 concluded that it could not say whether troops’ exposures to emissions from open-air burn pits caused ongoing health effects. The report left open the possibility that the burn pits or other sources of air pollution were the cause of respiratory problems in deployed troops.

Among the reasons for the IoM’s inconclusive results were “insufficient data” on troops’ exposures to open-air burn pits as well as high background levels of ambient pollution from other sources and lack of information on the quantities and composition of wastes burned in the pits, all of which “complicate interpretation of the data,” according to the authors.

Respiratory symptoms are recognized as a marker of chronic multi-symptom illness (CMI), also called Gulf War Illness. CMI is defined by the presence of chronic symptoms in more than one of six categories: fatigue, mood and cognition, musculoskeletal, gastrointestinal, respiratory and neurologic.

Recently, the Research Advisory Committee (RAC) on Gulf War Illnesses reported that exposures to pesticides and pyridostigmine bromide are causally associated with Gulf War illness.

“Gulf War illness is a serious physical disease, affecting at least 175,000 veterans of the 1990-1991 Gulf War that resulted from hazardous exposures in the Gulf War theater,” that report stated.

1Falvo MJ, Osinubi O, Klein JC et al. Durbin D, Kallan M, Elliott M. Late Prevalence of Pulmonary Function Abnormalities In Iraq/Afghanistan Veterans. Paper presented at: 2014 American Thoracic Society International Conference. May 2014; San Diego.

2Karlinsky JB, Blanchard M, Alpern R, Eisen SA, Kang H, Murphy FM, Reda DJ. Late prevalence of respiratory symptoms and pulmonary function abnormalities in Gulf War I Veterans. Arch Intern Med. 2004 Dec 13-27;164(22):2488-91. PubMed PMID: 15596641

 


22 Comments

  • Lorrie RN says:

    My husband returned 7 years ago from Army combat duty in Iraq.(he also served in the early Gulf war, Navy) Within one year post-deployment, he was unable to climb a flight of stairs. Dr’s were unable to explain severe shortness of breath. He was inappropriately diagnosed him with anxiety. 2 years later he was diagnosed with severe pulmonary arterial hypertension, a progressive debilitating lung disease. He continues to be denied service connection, as the condition could not be proven related to environmental considerations.Keeping in mind he was in perfect health before deployment.We now know that every soldier who served in the Middle East has had a respiratory exposure. It is a matter of time before symptoms manifest. In the last two years, a multitude of scientific research literature has been produced by the experts. What I would like to know is why, why, why are we still attempting to prove respiratory conditions are service connected? Our claim has been sitting in appeals for 5 years, while a veteran is dying of lung disease which has now affected cardiac function.The life expectancy for this condition is 5 years, even with medications, (that we have had to fight the VA to pay for). While society wonders why the suicide rate among veterans is so high, the federal government knows exactly why. What is this medical reasearch worth? Nothing

  • Lorrie RN says:

    My husband returned 7 years ago from Army combat duty in Iraq.(he also served in the early Gulf war, Navy) Within one year post-deployment, he was unable to climb a flight of stairs. Dr’s were unable to explain severe shortness of breath. He was inappropriately diagnosed him with anxiety. 2 years later he was diagnosed with severe pulmonary arterial hypertension, a progressive debilitating lung disease. He continues to be denied service connection, as the condition could not be proven related to environmental considerations.Keeping in mind he was in perfect health before deployment.We now know that every soldier who served in the Middle East has had a respiratory exposure. It is a matter of time before symptoms manifest. In the last two years, a multitude of scientific research literature has been produced by the experts. What I would like to know is why, why, why are we still attempting to prove respiratory conditions are service connected? Our claim has been sitting in appeals for 5 years, while a veteran is dying of lung disease which has now affected cardiac function.The life expectancy for this condition is 5 years, even with medications, (that we have had to fight the VA to pay for). While society wonders why the suicide rate among veterans is so high, the federal government knows exactly why. What is this medical reasearch worth? Nothing

  • janet radtke RN says:

    I was a flight nurse on a C130 for 6 months in Saudi Arabia for Operation Desert Storm. I have been a non smoker. I developed SOB last year and have been misdiagnosed since then with asthma. Just recently after no improvement with inhalers and medication, more testing was done and my VA pulmonologist dx me with Pulmonary Arterial Hypertension and referred me to a pulmonologist that strictly deals with this disease as one of 9 (only) medical centers that treat patients with this disease. I was denied disability and am now refiling for reconsideration. I am hopeful that at least I would be able to get an exam by a VA provider for consideration under the Gulf War Illness diagnoses.

  • janet radtke RN says:

    I was a flight nurse on a C130 for 6 months in Saudi Arabia for Operation Desert Storm. I have been a non smoker. I developed SOB last year and have been misdiagnosed since then with asthma. Just recently after no improvement with inhalers and medication, more testing was done and my VA pulmonologist dx me with Pulmonary Arterial Hypertension and referred me to a pulmonologist that strictly deals with this disease as one of 9 (only) medical centers that treat patients with this disease. I was denied disability and am now refiling for reconsideration. I am hopeful that at least I would be able to get an exam by a VA provider for consideration under the Gulf War Illness diagnoses.

  • Annie K says:

    I don’t think the government wants to admit the dangers many are in now. How do they justify testing 10 people? This ” Gulf War Illness” is real and the Government needs to start taking care of our Vets that are suffering from it.
    Maybe they need to rob a bank, go to jail then they will get Medical attention they need.
    What a sad situation they are in. 🙁

  • Annie K says:

    I don’t think the government wants to admit the dangers many are in now. How do they justify testing 10 people? This ” Gulf War Illness” is real and the Government needs to start taking care of our Vets that are suffering from it.
    Maybe they need to rob a bank, go to jail then they will get Medical attention they need.
    What a sad situation they are in. 🙁

  • Abby says:

    I’m a USAF veteran, 2003-2012. F15 maintainer. I’ve been fighting a dry chronic cough since deploying to Afghanistan in 2008. We drove past the burn pits and incinerators twice a day. Experienced at least two dust storms while we deployed. (Of course when is it NOT dusty there?) I deployed to the UAE in 2012 and again experienced two or three dust storms while there. I’ve registered with the burn pit registry. I’m currently waiting for a decision on my VA claim.

    It’s frustrating as I know something is wrong. I’ve had multiple pulmonary function tests and x-rays. I’ve been given inhalers and allergy medication, which of course do nothing.

  • Abby says:

    I’m a USAF veteran, 2003-2012. F15 maintainer. I’ve been fighting a dry chronic cough since deploying to Afghanistan in 2008. We drove past the burn pits and incinerators twice a day. Experienced at least two dust storms while we deployed. (Of course when is it NOT dusty there?) I deployed to the UAE in 2012 and again experienced two or three dust storms while there. I’ve registered with the burn pit registry. I’m currently waiting for a decision on my VA claim.

    It’s frustrating as I know something is wrong. I’ve had multiple pulmonary function tests and x-rays. I’ve been given inhalers and allergy medication, which of course do nothing.

  • Paula Coffer says:

    I entered the hospital complaining of shortness of breath and flu like symptoms. I was initially treated at both hospitals as if I had bilateral pneumonia and was administered massive amounts of antibiotics. On December 27 I underwent a Bronchoscopy and a biopsy was taken from within my lung. The results of the biopsy allowed me to be diagnosed with BOOP – Bronchiolitis Obliterans Organizing Pneumonia also known as Epler’s Pneumonia and sometimes referred to as COP.
    This is a rare (prevalence in the US of .01%) idiopathic (unknown cause) condition. One of the potential causal items listed is toxic fumes. The burn pits and general environment of living in Kabul, Afghanistan certainly apply here. Kabul sits in the bowl of the Hindu Kush Mountains and has a terrific smog problem with an engorged population due to the continuing war. Within Kabul the local population freely burns anything available to stay warm and to cook; wood, vehicle tires, plastic of any kind and in general anything burnable that they can acquire. There is of course the fecal matter in the air from the brick factory near the airport. The toxic fumes from all this may very well be the contributing factor for the health issues I’m experiencing now.
    My advice to each of you is this: If you begin to have any flu like symptoms accompanied by shortness of breath DO NOT DELAY going to a medical facility. Upon admission mention BOOP and exposure to toxic fumes for an extended time. This will alert the medical staff to perform a CT Scan and involve a Pulmonary physician to evaluate and then perform a Bronchoscopy or open lung biopsy to confirm or deny POOP. You will not respond to antibiotics. The resolution for BOOP is steroids – Prednisone for an extended time.
    As this is such a rare condition I recommend you pass this to every battle buddy who served in the middle east; Iraq, Kuwait, Syria or Afghanistan to help them in the event they begin to show signs as it will be misdiagnosed through CT scans and X-Rays. It is already known that those us serving in the middle east have lung issues from the general desert/sand environment so it is recommended that lung checkups be performed periodically.

  • LTC MAC says:

    I served in both Gulf I and Operation Enduring Freedom. Since returning from Iraq in 2009 following a 15 month deployment, I have been hospitalized ove 10 times for lung conditions including pneumonia several times. I have been diagnosed with COPD, Asthma, chronic Obstructive Airway disease. In 3 recent CT Scans My lungs went fro clear to having ground glass opacity. Infiltrates in the medial basal segment of my right lower lobe. The second CT determine the ground glass density 1.1×1.9x.09cm. Last week a new CT found the glass opacity has increase since a CT in November 16. I have extreme coughing and a lot of fluid come up when I cough. I am taking nebulizer treatments twice a day with ipratropium Bromide, Symbicort inhaler, and ProAir rescue inhaler. My condition sometime has spells where I am ok, but them like now I am in fullblown attack mode. Like many of our other soldiers I was healthy before my deployments, but now have a difficult time breathing. I the VA has denied my claim and have been waiting for my appeal Claim which went before a Judge in Dec 2015.

  • LTC MAC says:

    I served in both Gulf I and Operation Enduring Freedom. Since returning from Iraq in 2009 following a 15 month deployment, I have been hospitalized ove 10 times for lung conditions including pneumonia several times. I have been diagnosed with COPD, Asthma, chronic Obstructive Airway disease. In 3 recent CT Scans My lungs went fro clear to having ground glass opacity. Infiltrates in the medial basal segment of my right lower lobe. The second CT determine the ground glass density 1.1×1.9x.09cm. Last week a new CT found the glass opacity has increase since a CT in November 16. I have extreme coughing and a lot of fluid come up when I cough. I am taking nebulizer treatments twice a day with ipratropium Bromide, Symbicort inhaler, and ProAir rescue inhaler. My condition sometime has spells where I am ok, but them like now I am in fullblown attack mode. Like many of our other soldiers I was healthy before my deployments, but now have a difficult time breathing. I the VA has denied my claim and have been waiting for my appeal Claim which went before a Judge in Dec 2015.

  • Scott Wolf says:

    I have breathing issues also .I have gone to a C&P and was told”If you were to have Asthma it would have been right away” and was denied! Now I am going to a Dr. outside of the VA as I do not trust them like I did in the past.
    I served in 1991 Gulf War and was there when khamisiyah was blown up full of Chem weapons.Oil fires sand storms , Pyridostigmine Bromide pills. Shots for chemical weapons before leaving Germany. I was ready to end it about 2 years ago because of losing too much work and the inability to function as a person. I was able to get symbicort and it seems to help,But yet they will not admit to gulf war as the issue.

  • Scott Wolf says:

    I have breathing issues also .I have gone to a C&P and was told”If you were to have Asthma it would have been right away” and was denied! Now I am going to a Dr. outside of the VA as I do not trust them like I did in the past.
    I served in 1991 Gulf War and was there when khamisiyah Iraq was blown up full of Chem weapons,Oil fires sand storms , Pyridostigmine Bromide pills, shots for chemical weapons before leaving Germany. I was ready to end it about 2 years ago because of losing too much work and the inability to function as a person. I was able to get symbicort and it seems to help,But yet they will not admit to gulf war as the issue.

  • Scott Wolf says:

    I have breathing issues also .I have gone to a C&P and was told”If you were to have Asthma it would have been right away” and was denied! Now I am going to a Dr. outside of the VA as I do not trust them like I did in the past.
    I served in 1991 Gulf War and was there when khamisiyah was blown up full of Chem weapons.Oil fires sand storms , Pyridostigmine Bromide pills. Shots for chemical weapons before leaving Germany. I was ready to end it about 2 years ago because of losing too much work and the inability to function as a person. I was able to get symbicort and it seems to help,But yet they will not admit to gulf war as the issue.

  • Donald L. Hardwick Jr says:

    I too have been diagnosed with BOOP Dec 2016. Served in first Gulf War Jan 91-May 2 91 Ist Inf Div 101st MI Bn HSC. I also have been diagnosed with COPD, shortness of breath, small airway obstruction, autoimmune disease (Transverse Myelitis), diffused idiopathic skeletal hyperotosis, chronic bronchitis, peripheral neuropathy of both legs with heavy nerve damage caused by the transverse myelitis!! of course I was exposed to toxic fumes while in Saudia Arabia, Iraq and Kuwait. The BOOP has been confirmed by a lung biopsy.

  • Donald L. Hardwick Jr says:

    I too have been diagnosed with BOOP Dec 2016. Served in first Gulf War Jan 91-May 2 91 Ist Inf Div 101st MI Bn HSC. I also have been diagnosed with COPD, shortness of breath, small airway obstruction, autoimmune disease (Transverse Myelitis), diffused idiopathic skeletal hyperotosis, chronic bronchitis, peripheral neuropathy of both legs with heavy nerve damage caused by the transverse myelitis!! of course I was exposed to toxic fumes while in Saudia Arabia, Iraq and Kuwait. The BOOP has been confirmed by a lung biopsy.

  • Jeremiah says:

    I served 3 deployments in Iraq and two in Afghanistan. We all had respiratory issues over seas(chronic cough) due to all the dust. My symptoms slowly got progressively worse when I returned from my 3rd deployment to Iraq. I went to National Jewish, one of the top respiratory clinics in the country. They gave me a PFT and consult with a DR. Specializing in deployment related respiratory diseases. Her opinion was I had restrictive lung disease. The VA would not accept their report and sent me to a 3rd party pulmonologist. He scheduled a PFT and gave me a oxygen moniter to bring home for the night. The VA was pissed and told me not to go back to him. The DR called me back and said my o2 was 87 and the VA did not want any test, just a diagnosis which he could not do. The VA sent me to another Dr that administer a spirometry that showed restrictive. She had me do it two more times and it showed restrictive again. She was puzzled and said she still thought it was obstructive. The VA rated me at 30% but I’m using my private insurance to go back to the Dr the VA rejected. If I leave it to the gvt they will figure it out when I die.

  • Jeremiah says:

    I served 3 deployments in Iraq and two in Afghanistan. We all had respiratory issues over seas(chronic cough) due to all the dust. My symptoms slowly got progressively worse when I returned from my 3rd deployment to Iraq. I went to National Jewish, one of the top respiratory clinics in the country. They gave me a PFT and consult with a DR. Specializing in deployment related respiratory diseases. Her opinion was I had restrictive lung disease. The VA would not accept their report and sent me to a 3rd party pulmonologist. He scheduled a PFT and gave me a oxygen moniter to bring home for the night. The VA was pissed and told me not to go back to him. The DR called me back and said my o2 was 87 and the VA did not want any test, just a diagnosis which he could not do. The VA sent me to another Dr that administer a spirometry that showed restrictive. She had me do it two more times and it showed restrictive again. She was puzzled and said she still thought it was obstructive. The VA rated me at 30% but I’m using my private insurance to go back to the Dr the VA rejected. If I leave it to the gvt they will figure it out when I die.

  • Teresa Watson says:

    Yes my husband was also at Khamisiyah, and suffers from copd and sleep apnea, he was also and has buddy statements that they were in the oil well fire smoke for three weeks, and many in his unit have the same problems. Went to VA and tried to get disability and the VA said he was a liar and flagged him as such. So no did not get benefits, no lawyer will take him, and it is frustrating.

  • Scott Wolf says:

    I have breathing issues also .I have gone to a C&P and was told”If you were to have Asthma it would have been right away” and was denied! Now I am going to a Dr. outside of the VA as I do not trust them like I did in the past.
    I served in 1991 Gulf War and was there when khamisiyah Iraq was blown up full of Chem weapons,Oil fires sand storms , Pyridostigmine Bromide pills, shots for chemical weapons before leaving Germany. I was ready to end it about 2 years ago because of losing too much work and the inability to function as a person. I was able to get symbicort and it seems to help,But yet they will not admit to gulf war as the issue.

  • Paula Coffer says:

    I entered the hospital complaining of shortness of breath and flu like symptoms. I was initially treated at both hospitals as if I had bilateral pneumonia and was administered massive amounts of antibiotics. On December 27 I underwent a Bronchoscopy and a biopsy was taken from within my lung. The results of the biopsy allowed me to be diagnosed with BOOP – Bronchiolitis Obliterans Organizing Pneumonia also known as Epler’s Pneumonia and sometimes referred to as COP.
    This is a rare (prevalence in the US of .01%) idiopathic (unknown cause) condition. One of the potential causal items listed is toxic fumes. The burn pits and general environment of living in Kabul, Afghanistan certainly apply here. Kabul sits in the bowl of the Hindu Kush Mountains and has a terrific smog problem with an engorged population due to the continuing war. Within Kabul the local population freely burns anything available to stay warm and to cook; wood, vehicle tires, plastic of any kind and in general anything burnable that they can acquire. There is of course the fecal matter in the air from the brick factory near the airport. The toxic fumes from all this may very well be the contributing factor for the health issues I’m experiencing now.
    My advice to each of you is this: If you begin to have any flu like symptoms accompanied by shortness of breath DO NOT DELAY going to a medical facility. Upon admission mention BOOP and exposure to toxic fumes for an extended time. This will alert the medical staff to perform a CT Scan and involve a Pulmonary physician to evaluate and then perform a Bronchoscopy or open lung biopsy to confirm or deny POOP. You will not respond to antibiotics. The resolution for BOOP is steroids – Prednisone for an extended time.
    As this is such a rare condition I recommend you pass this to every battle buddy who served in the middle east; Iraq, Kuwait, Syria or Afghanistan to help them in the event they begin to show signs as it will be misdiagnosed through CT scans and X-Rays. It is already known that those us serving in the middle east have lung issues from the general desert/sand environment so it is recommended that lung checkups be performed periodically.

  • Teresa Watson says:

    Yes my husband was also at Khamisiyah, and suffers from copd and sleep apnea, he was also and has buddy statements that they were in the oil well fire smoke for three weeks, and many in his unit have the same problems. Went to VA and tried to get disability and the VA said he was a liar and flagged him as such. So no did not get benefits, no lawyer will take him, and it is frustrating.


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