Many Iraq/Afghanistan War Veterans Need Lung Function Testing: ACOEM

The researchers suggest a number of possible explanations for lung injury in soldiers with IAW-LI, such as inhaling sharp and coarse dust grains, toxins, and allergens in the in the harsh, polluted combat environment.

Many soldiers returning from Iraq or Afghanistan have a newly recognized condition that leads to the need for lung function testing, reports a paper in the September Journal of Occupational and Environmental Medicine, official publication of the American College of Occupational and Environmental Medicine.

Led by Dr. Anthony M. Szema of the Veterans Affairs Medical Center in Northport, N.Y., the researchers proposed the term "Iraq/Afghanistan War Lung Injury" (IAW-LI) to describe the new condition. "New-onset IAW-LI is common…rates of symptoms leading to a diagnosis requiring spirometry are high," the researchers wrote.

Szema and colleagues analyzed health data on more than 7,000 active-duty soldiers in the New York City/Long Island area. About one-fourth had been deployed to Iraq or Afghanistan, while the rest served elsewhere.

The percentage of soldiers undergoing a test called spirometry to evaluate lung function was compared between groups. The respiratory symptoms leading to spirometry were analyzed, along with the test results.

Of soldiers returning from Iraq or Afghanistan, 14.5 percent had respiratory symptoms leading to spirometry, compared to 1.8 percent of those serving elsewhere. Although the rate of smoking was much higher among Iraq/Afghanistan veterans (about 35 versus 5 percent), this could not completely explain the difference in respiratory symptoms.

Previous studies have suggested that Iraq/Afghanistan War veterans have a higher rate of asthma than stateside-based troops. However, the spirometry results are more consistent with some type of lung injury (causing irreversible declines in lung function) rather than asthma (causing reversible declines). Szema and colleagues propose the term IAW-LI for this clinical syndrome of "fixed airway obstruction as a result of lung injury."

The researchers suggest a number of possible explanations for lung injury in soldiers with IAW-LI, such as inhaling sharp and coarse dust grains, toxins, and allergens in the in the harsh, polluted combat environment. Lung damage caused by blast pressure or shock waves from improvised explosive devices is another possible cause.

Another potential contributor is smoke from exposure to open burn pits, in which trash is ignited with jet fuel and burned. For example, burning plastic water bottles leads to release of a chemical known to cause occupational asthma.

Szema and coauthors identify some preventive steps that might help to address these potential causes of lung injury: using incinerators rather than trash pits, recycling rather than burning plastic water bottles, and increasing the use of respiratory protection devices.

Further study is needed to clarify the incidence, causes, and appropriate treatment for IAW-LI. Meanwhile, Szema and colleagues suggest that all soldiers returning from Iraq or Afghanistan should undergo spirometry to screen for reduced lung function. They added, "The study has the potential to inform recommendations regarding force health protection guidance with respect to trash disposal, occupational health regulations, decisions regarding applications for disability due to lung disease, and medical follow-up and screening of veterans deployed to Iraq."

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