Longitudinal changes in lung function following post-9/11 military deployment in symptomatic veterans

• Published in: Respiratory medicine Vol. 227; p. 107638
• Main Authors: Zell-Baran, Lauren M., Krefft, Silpa D., Strand, Matthew, Rose, Cecile S.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.06.2024
• Subjects: Adult; Afghan Campaign 2001; Asthma; Asthma - epidemiology; Asthma - physiopathology; Bronchiolitis; Burn pits; Deployment-related respiratory diseases; Female; Forced Expiratory Volume - physiology; Humans; Iraq War, 2003-2011; Longitudinal pulmonary function; Longitudinal Studies; Lung - physiopathology; Lung Diseases - epidemiology; Lung Diseases - etiology; Lung Diseases - physiopathology; Male; Middle Aged; Military Deployment; Occupational Diseases - epidemiology; Occupational Diseases - etiology; Occupational Diseases - physiopathology; Occupational Exposure - adverse effects; Respiratory Function Tests; September 11 Terrorist Attacks; Spirometry; United States - epidemiology; Veterans; Vital Capacity - physiology; United States; Burn pits; Deployment-related respiratory diseases; Longitudinal pulmonary function; Asthma; Bronchiolitis
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2024.107638

Exposure to burn pit smoke, desert and combat dust, and diesel exhaust during military deployment to Southwest Asia and Afghanistan (SWA) can cause deployment-related respiratory diseases (DRRDs) and may confer risk for worsening lung function after return. Study subjects were SWA-deployed veterans who underwent occupational lung disease evaluation (n = 219). We assessed differences in lung function by deployment exposures and DRRD diagnoses. We used linear mixed models to assess changes in lung function over time. Most symptomatic veterans reported high intensity deployment exposure to diesel exhaust and burn pit particulates but had normal post-deployment spirometry. The most common DRRDs were deployment-related distal lung disease involving small airways (DDLD, 41%), deployment-related asthma (DRA, 13%), or both DRA/DDLD (24%). Those with both DDLD/DRA had the lowest estimated mean spirometry measurements five years following first deployment. Among those with DDLD alone, spirometry measurements declined annually, adjusting for age, sex, height, weight, family history of lung disease, and smoking. In this group, the forced expiratory volume in the first second/forced vital capacity (FEV1/FVC) ratio declined 0.2% per year. Those with more intense inhalational exposure had more abnormal lung function. We found significantly lower estimated FVC and total lung capacity five years following deployment among active duty participants (n = 173) compared to those in the reserves (n = 26). More intense inhalational exposures were linked with lower post-deployment lung function. Those with distal lung disease (DDLD) experienced significant longitudinal decline in FEV1/FVC ratio, but other DRRD diagnosis groups did not. •Deployment to Southwest Asia may increase risk for worsening lung function.•Longitudinal analysis in symptomatic veterans shows variability among diagnosis groups.•Those with both small and large airways disease are most affected.•More intense deployment exposures are linked to worse lung function.•Veterans with large and small airways disease should be monitored regularly.