Public Release: 

Late pulmonary function abnormalities are common among Iraq/Afghanistan veterans

American Thoracic Society

ATS 2014, SAN DIEGO ─ Pulmonary function abnormalities may be a precursor to chronic respiratory disease in Iraq/Afghanistan and Gulf War veterans years after their deployment, according to a new study presented at the 2014 American Thoracic Society International Conference.

"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 U.S. Department of Veterans Affairs' New Jersey 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."

Small airway obstruction may lead to asthma, COPD, or other respiratory problems.

The retrospective study included 63 Gulf War veterans approximately 20 years post-deployment and 70 Iraq/Afghanistan veterans approximately 10 years post-deployment. Pulmonary function abnormalities were assessed with spirometry. Among the Gulf War veterans, the rate of small airway obstruction was five times greater (38% vs. 7%) than that seen in a reference group from an earlier population-based sample of Gulf War veterans evaluated 10-years post-deployment, and the rate of restrictive lung physiology was two times greater (24% vs. 12%). Among the Iraq/Afghanistan veterans, the rate of small airway obstruction was also five times greater (31% vs. 7%). Rates of non-reversible airway obstruction were significantly lower in the study groups than in the reference sample.

"The veterans we evaluated exhibited unique spirometry patterns," said Dr. Falvo. "If confirmed in larger studies, these patterns may indicate a higher risk for progression to chronic respiratory disease and may allow for early 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."


* Please note that numbers in this release may differ slightly from those in the abstract. Many of these investigations are ongoing; the release represents the most up-to-date data available at press time.

Abstract 54486

Late Prevalence Of Pulmonary Function Abnormalities In Iraq/Afghanistan Veterans
Type: Scientific Abstract
Category: 01.20 - Occupational and Environmental Respiratory Diseases (EOH)
Authors: M.J. Falvo1, O. Osinubi1, J.C. Klein1, L. Patrick DeLuca1, W.A. Smith2, D.A. Helmer1; 1Veterans Affairs NJ Health Care System - East Orange,
NJ/US, 2University of Memphis - Memphis, TN/US

Abstract Body

RATIONALE: Prior studies in both US and Australian 1991 Gulf War veterans observed no clinically significant pulmonary abnormalities in deployed veterans despite the presence of symptoms that persist even 20 years later. Recent studies have observed increased respiratory symptom reporting in veterans of Iraq and Afghanistan (IAV) up to 10 years postdeployment. Therefore, we compared patterns of pulmonary function abnormalities in Gulf War and IAV veterans evaluated at our postdeployment tertiary care clinic in comparison to a previously published population-based sample of Gulf War veterans evaluated 10-years post-deployment (Karlinsky et al. 2004; Arch Intern Med).

METHODS: Pulmonary function reports from Gulf War (n = 63) and IAV (n = 70) veterans evaluated at our clinic were retrospectively analyzed to classify veterans into the following categories: 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 previously published study (Karlinsky et al.) were used for consistency.

RESULTS: Please see the accompanying figure. Patterns of pulmonary function abnormalities were significantly different (p<0.05) such that rates of RLP and SAO for Gulf War veterans evaluated at our center were 2- and 5-times greater than the referent group. Similarly, the proportion of SAO was also 5-fold greater in IAV in comparison to our referent group. However, rates of NRAO were significantly lower in our sample (<1%) in comparison to the referent group (16%). Similar patterns were observed between IAV and Gulf War veterans evaluated at our center.

CONCLUSIONS: Our findings are generally consistent with previous studies demonstrating NPF in the majority of Gulf War and IAV veterans. However, veterans evaluated at our postdeployment health clinic approximately 20- (Gulf War) and 10- (IAV) years postdeployment demonstrate unique spirometry patterns. In comparison to the referent group, we observed significantly higher rates of RLP (24% vs. 12%) and SAO (38% vs. 7%) in our sample of Gulf War veterans, and SAO (31% vs. 7%) in IAV. However, rates of NRAO were significantly lower (16% vs. <1%) in both cohorts of veterans evaluated at our clinic. Confirmation of these spirometry patterns is necessary in larger population-based samples. However, 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.

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