WASHINGTON – The U.S. military’s love affair with tobacco may be officially over, but the federal healthcare system is still dealing with the aftermath, especially chronic conditions such as chronic obstructive pulmonary disease (COPD).
The DoD now has an intense focus on smoking cessation, but that is a more recent development. Cigarettes were included in C-rations until 1975, and World War II advertisements for smoking often featured servicemembers in uniform.
Even now, cigarettes are sold discounted at military bases throughout the world, although the VA has banned the sale at retail outlets in its VAMCs.
More than 30% of military personnel smoke, a rate 50% more prevalent than in the civilian population, according to an Institute of Medicine (IoM) report in 2009. The smoking rate during deployment has been estimated to be as high as 50%.
Smoking rates also remain considerably higher among veterans than the civilian population, according to the national Centers for Disease Control and Prevention.
The CDC reports that, in men aged 25–64 during 2007–2010, 29% of veterans reported being current cigarette smokers, compared with 24% of those who had not served in the military. The rates are especially high among middle-aged veterans, with 36% of 45-54-year-old veterans reporting that they currently smoke, compared with 24% of those who had not served in the military.
It should come as no surprise, therefore, that COPD is the fourth most common diagnosis among hospitalized veterans.
“Within VA, COPD is about four times more prevalent than in the general population, largely because of tobacco exposure and the high rate of current and past tobacco use. Research shows that smoking accounts for about 80% of COPD deaths,” said David Au, MD, investigator in the VA’s Northwest Center of Excellence and associate professor of medicine and pharmacy at the University of Washington in Seattle. “The No. 1 treatment is tobacco cessation, which in a 14-year randomized clinical trial, the Lung Health Study in 2005-2006, was clearly shown to reduce mortality.”
The number of COPD patients is likely to increase beyond the about 1 million currently treated at the VHA. A report from the House Committee on Veterans’ Affairs estimated that prevalence of airflow limitation is 33%-43% among VHA patients, indicating high rates of undiagnosed disease.
Already, the long-term costs are nothing short of astronomical. The VA spent more than $6 billion in 2008 treating diseases such as COPD. The IoM found, meanwhile, that DoD’s cost of treating tobacco-related diseases is estimated to be more than $500 million per year for medical care and $346 million in lost productivity.
In the active-duty military, patients who respond to simple therapy have no service restrictions, but the need for medication to manage chronic disease can limit service.
Another factor that could affect future COPD rates is the number of troops exposed to burn pits, dust, chemicals and other environmental risk factors, particularly in Iraq and Afghanistan.
Currently, respiratory cancers are considered presumptively service connected to herbicide exposure (i.e. Agent Orange), but restrictive lung diseases such as COPD are not.