Anays Sotolongo

Respiratory symptoms were associated with lower spirometry results during the first examination of WTC responders.

Objective: Determine if World Trade Center (WTC) disaster responders had lower lung function and higher bronchodilator responsiveness than those with respiratory symptoms and conditions. Methods: We evaluated cardinal respiratory symptoms (dyspnea, wheezing, dry cough, productive cough) and determined the difference in FEV1, FVC, and bronchodilator responsiveness. Results: All respiratory symptoms were associated with a lower FEV1 and FVC, and a larger bronchodilator response. Responders reporting chronic productive cough, starting during WTC work and persisting, had a mean FEV1 109 mL lower than those without chronic persistent cough; their odds of having abnormally low FEV1 was 1.40 times higher; and they were 1.65 times as likely to demonstrate bronchodilator responsiveness. Conclusions: Responders reporting chronic persistent cough, wheezing or dyspnea at first medical examination were more likely to have lower lung function and bronchodilator responsiveness.

Bronchodilator Responsiveness and Airflow Limitation Are Associated With Deployment Length in Iraq and Afghanistan Veterans.

Objective: The aim of this study was to determine the relationship between deployment length and indices of airflow obstruction in Iraq and Afghanistan veterans with airborne hazards exposure. Methods: One hundred twenty-four post-9/11 veterans completed pulmonary function testing and questionnaires. We examined the association of airflow limitation [forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC)] and bronchodilator responsiveness (&Dgr;FEV1 and &Dgr;FVC) with deployment length, adjusting for smoking. Results: Longer deployment length was associated with lower FEV1/FVC [&bgr; = −0.19; 95% confidence interval (95% CI), −0.39 to 0.01], greater &Dgr;FEV1 (&bgr; = 0.27; 95% CI, 0.09 to 0.45) and &Dgr;FVC (&bgr; = 0.19; 95% CI, 0.05 to 0.33). In our model adjusted for smoking history, longer deployment length remained associated with greater &Dgr;FEV1 and &Dgr;FVC (P < 0.01), but not with FEV1/FVC (P = 0.059). Conclusion: In our sample of post-9/11 veterans, longer deployment lengths were associated with significant bronchodilator responsiveness and a trend toward airflow limitation independent of tobacco use.

Blast Injury and Cardiopulmonary Symptoms in U.S. Veterans: Analysis of a National Registry

Background: Recent epidemiologic studies have reported an increased risk for respiratory conditions in service members deployed to Iraq or Afghanistan (1) since 2001 and an increasing prevalence of chronic lung disease in this population (2). Reports of dyspnea and exercise intolerance have mostly been attributed to exposure to airborne hazards, such as burn-pit smoke and particulate matter. Exposure to blast waves during military deployment has been recognized as the hallmark injury of the wars in Iraq and Afghanistan, and considerable efforts have been made to understand the associated neurologic sequelae. However, less attention has been paid to the lungs, which may be particularly susceptible to blast waves given tissue-density gradients. The exact relationship between blast lung injury and long-term sequelae is unknown; however, animal models show long-term, persistent elevations in oxidative stress and vascular abnormalities after blast exposure (3), which may contribute to respiratory symptoms. Associations between blast exposure and chronic lung diseases in this cohort have recently been suggested (2). Objective: To study the association between blast exposure and current cardiopulmonary symptoms. Methods and Findings: In June 2014, the U.S. Department of Veterans Affairs and Department of Defense launched the Airborne Hazards and Open Burn Pit Registry (AHOBPR) to ascertain and monitor health effects and health care in approximately 3 million veterans and service members deployed to southwest Asia, Djibouti, or Afghanistan since July 1990. The major domains of this voluntary online survey include deployment history, symptoms and medical health, and occupational and environmental exposures. Between June 2014 and 31 July 2015, a total of 42558 registry participants who were deployed after 7 October 2001 completed the AHOBPR questionnaire (Table). The outcome of interest was self-reported current dyspnea and/or decreased ability to exercise in response to the question, Do you currently have any of the following symptoms? Exposure to a blast was determined by an affirmative response to the question, Were you ever close enough to feel the blast from an IED (improvised explosive device) or other explosive device? Table. Characteristics of Registry Participants Deployed After 7 October 2001* All statistical analyses were performed using SAS Enterprise Guide, version 7.1 (SAS Institute). Most participants (61.0%) reported dyspnea or decreased exercise tolerance; 59.1% reported both. Time from last deployment to start of the survey was a mean of 62.2 months (SD, 37.2) and a median of 57.0 months (range, 0 to 162.0 months). Self-reported exposure to blast was 73.7% overall but was higher among those with symptoms (20512 [79.0%]) than those without symptoms (10860 [65.5%]). To further explore the hypothesized relationship between blast exposure and cardiopulmonary symptoms, we used a multivariate model, controlling for the following potential self-reported confounders: age; sex; branch of service; body mass index; smoking status; exposure to burn-pit smoke; nonmilitary occupational exposure to dust, gas, smoke, chemical vapors, or fumes; and time since deployment. Missing data for burn-pit smoke exposure (17% of records) were estimated using multiple imputation (PROC MI FCS discriminant method [SAS Institute], with 25 imputed data sets and 2 auxiliary variables associated with burn-pit exposure included in the imputation model). We observed an association between current symptoms and self-reported blast exposure (adjusted odds ratio, 1.66 [95% CI, 1.5 to 1.7]), controlling for the covariates. Conclusion: We found a moderate, independent association between self-reported blast exposure and current symptoms of dyspnea and/or decreased exercise tolerance in U.S. military service members who were deployed after 7 October 2001 and had completed the AHOBPR. Our findings are biologically plausible and supported by animal studies showing impaired cardiopulmonary function secondary to blast injury (4). Further, this study corroborates a report of increased risk for chronic lung disease among deployed veterans of the wars in Iraq and Afghanistan with a history of traumatic brain injurya potential proxy for blast exposure (2). The results of this study are intended to generate hypotheses and must be confirmed by more rigorous epidemiologic and clinical studies. The voluntary nature of the AHOBPR is associated with a lack of generalizability of the findings because of the nonrepresentative sample. In addition, the self-reported responses raise the possibility of exaggerated reporting of symptoms and exposure and of incomplete or inaccurate recall (5). Despite the lack of information on the number, timing, or severity of blast exposure or nature of acute symptoms, the independent association between self-reported blast and current symptoms suggests a robust relationship. Our findings indicate that blast exposure may have a discernable effect on symptoms and exercise capacity even several years after the exposure. If these findings are confirmed, clinicians should consider and document blast exposure as a possible contributing factor in patients with persistent or latent cardiopulmonary symptoms after deployment. In parallel, a focus on burn-pit smoke exposure as the cause of adverse cardiopulmonary effects may be incomplete and misattributed in some cases. Recognizing the possible importance of blast-related lung injury may accelerate research that can clarify the relevance of such injuries.

Isolated diffusing capacity reduction is a common clinical presentation in deployed Iraq and Afghanistan veterans with deployment‐related environmental exposures

Following deployment to Iraq and Afghanistan (“post‐9/11”), a spectrum of respiratory conditions has been reported; however, there are few published reports of objective physiologic data or later experience of symptoms and function. To better understand the post‐deployment clinical presentation, we conducted a retrospective review of pulmonary function testing in 143 veterans referred to our tertiary care clinic for post‐deployment health concerns. More than 75% of our sample had normal lung volumes and spirometry on pulmonary function testing; however, an isolated reduction in lung diffusing capacity (DLCO) was observed in 30% of our sample of post‐9/11 veterans. An isolated reduction in DLCO is a rare pattern in primary‐care seeking dyspneic patients, but is commonly associated with underlying pulmonary disease. Post‐9/11 veterans with respiratory complaints and an isolated reduction in DLCO should undergo further evaluation.