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Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations (2020)

Chapter:Appendix C: Epidemiologic Studies of Respiratory Health Outcomes in Southwest Asia Theater Veterans Newly Reviewed* by the Committee

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Suggested Citation:"Appendix C: Epidemiologic Studies of Respiratory Health Outcomes in Southwest Asia Theater Veterans Newly Reviewed* by the Committee." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
×

Appendix C

Epidemiologic Studies of Respiratory Health Outcomes in Southwest Asia Theater Veterans Newly Reviewed
*by the Committee

Referencea Population 1990–1991 Gulf War Post-9/11 Study Populationb Outcomes Assessedc Smoking Status Collectedd
Abraham and Baird, 2012 U.S. active-duty service members X Asthma;
COPD;
Pneumonia
Abraham et al., 2012 U.S. service members X Respiratory Symptoms (ICD-9-CM 786);
Asthma;
COPD;
Chronic Bronchitis
Abraham et al., 2014 U.S. service members X AFHSC Respiratory Symptoms (ICD-9-CM 786);
Asthma;
COPD
Baird et al., 2012 U.S./active-duty Army personnel X Respiratory Symptoms (ICD-9-CM 786);
Sinusitis and Rhinitis;
Asthma;
COPD;
Acute Bronchitis (ICD-9CM 460–466)
Banoei et al., 2019 U.S. veterans X X Interstitial Lung Disease (sarcoidosis)
Barth et al., 2014 U.S. veterans X NewGen Sinusitis and Rhinitis;
Asthma;
Chronic Bronchitis
X
Suggested Citation:"Appendix C: Epidemiologic Studies of Respiratory Health Outcomes in Southwest Asia Theater Veterans Newly Reviewed* by the Committee." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
×
Referencea Population 1990–1991 Gulf War Post-9/11 Study Populationb Outcomes Assessedc Smoking Status Collectedd
Barth et al., 2016a U.S. veterans X NewGen Sinusitis and Rhinitis;
Asthma;
Chronic Bronchitis
X
Barth et al., 2016b U.S. veterans X Mortality
Bollinger et al., 2015 U.S. veterans X Mortality
Butzko et al., 2019 U.S. veterans X WRIISC Pulmonary Function Testing X
Davy et al., 2012 Australian Defence Force active-duty personnel X Pulmonary Function Testing;
COPD
X
DelVecchio et al., 2015 U.S. active-duty Army personnel X Asthma
Díaz Santana et al., 2017 U.S. veterans X NewGen Sleep Apnea
Dion et al., 2013 U.S. Army soldiers X Vocal Cord Dysfunction X
Eick et al., 2011 U.S. active-duty service members X Pneumonia
Falvo et al., 2016a U.S. veterans X WRIISC Pulmonary Function Testing X
Falvo et al., 2016b U.S. veterans X WRIISC Pulmonary Function Testing
Forbes et al., 2019 U.S. active-duty service members X Interstitial Lung Disease (sarcoidosis)
Gwini et al., 2016 Australian veterans X Sleep Apnea;
Asthma
X
Hines et al., 2013 U.S. veterans X VA Depleted Uranium Surveillance Program Respiratory Symptoms (frequent cough, coughing up phlegm, shortness of breath, wheezing);
Sinusitis and Rhinitis;
Pulmonary Function Testing;
Asthma;
Emphysema
X
Holley et al., 2016 U.S. service members, National Guard/reserves X Pulmonary Function Testing X
Suggested Citation:"Appendix C: Epidemiologic Studies of Respiratory Health Outcomes in Southwest Asia Theater Veterans Newly Reviewed* by the Committee." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
×
Referencea Population 1990–1991 Gulf War Post-9/11 Study Populationb Outcomes Assessedc Smoking Status Collectedd
Hooper et al., 2008 U.S. active-duty veterans of Gulf War X Sinusitis and Rhinitis;
Interstitial Lung Disease (sarcoidosis);
Pneumonia
Jani et al., 2017a U.S. service members X AH&OBP Registry/WRIISC Respiratory Symptoms (dyspnea, decreased exercise tolerance) X
Jani et al., 2017b U.S. service members X AH&OBP Registry Constrictive Bronchiolitis X
Khalil et al., 2018 U.S. veterans X Gulf War Era Cohort and Biorepository Respiratory Symptoms (difficulty breathing, shortness of breath, frequent coughing without a cold, wheezing in chest);
Sleep Apnea;
COPD;
Emphysema;
Constrictive Bronchiolitis;
TB;
Cancers
King et al., 2011 U.S. active-duty Army soldiers X Constrictive Bronchiolitis X
Krefft et al., 2017 U.S. veterans X Respiratory Symptoms (cough, chest tightness, wheezing, shortness of breath, decreased exercise tolerance);
Pulmonary Function Testing;
Emphysema;
Constrictive Bronchiolitis;
Interstitial Lung Disease (hypersensitivity pneumonitis)
X
Krefft et al., 2020 U.S. service members X Pulmonary Function Testing;
Emphysema;
Constrictive Bronchiolitis;
Interstitial Lung Disease (hypersensitivity pneumonitis)
X
Lindheimer et al., 2019 U.S. veterans X WRIISC Pulmonary Function Testing X
Suggested Citation:"Appendix C: Epidemiologic Studies of Respiratory Health Outcomes in Southwest Asia Theater Veterans Newly Reviewed* by the Committee." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
×
Referencea Population 1990–1991 Gulf War Post-9/11 Study Populationb Outcomes Assessedc Smoking Status Collectedd
Liu et al., 2016 U.S. service members X AH&OBP Registry Asthma;
COPD;
Emphysema;
Chronic Bronchitis
X
Madar et al., 2017 U.S. military personnel X X Pulmonary Function Testing;
Constrictive Bronchiolitis;
Interstitial Lung Disease (sarcoidosis, acute eosinophilic pneumonia, pulmonary alveolar proteinosis, idiopathic interstitial pneumonia)
X
Matthews et al., 2014 U.S. active-duty service members X Pulmonary Function Testing;
COPD;
Emphysema
X
Maule et al., 2018 Veterans (Australia, Denmark, United Kingdom, United States) X Respiratory Symptoms (coughing, wheezing, shortness of breath);
Sinusitis and Rhinitis;
Asthma
Morris et al., 2014 U.S. active-duty service members X STAMPEDE Respiratory Symptoms (dyspnea, cough, wheeze, sputum production);
Pulmonary Function Testing
Morris et al., 2019 U.S. active-duty Army personnel X STAMPEDE Respiratory Symptoms (dyspnea, cough, wheezing, sputum production, exercise intolerance);
Pulmonary Function Testing
X
Morris et al., 2020 U.S. service members X STAMPEDE Respiratory Symptoms (exertional dyspnea, cough, wheeze, sputum production, decreased exercise tolerance);
Pulmonary Function Testing;
Constrictive Bronchiolitis
X
OIF SAPEG, 2003 U.S. active duty military personnel, Reserve/National Guard X Interstitial Lung Disease (acute eosinophilic pneumonia) X
Suggested Citation:"Appendix C: Epidemiologic Studies of Respiratory Health Outcomes in Southwest Asia Theater Veterans Newly Reviewed* by the Committee." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
×
Referencea Population 1990–1991 Gulf War Post-9/11 Study Populationb Outcomes Assessedc Smoking Status Collectedd
Peacock et al., 1997 U.S. veterans X Comprehensive Clinical Evaluation Program Sleep Apnea
Pugh et al., 2016 U.S. veterans X Asthma;
COPD;
Interstitial Lung Disease
X
Rivera et al., 2018 U.S. service members, Reserve/National Guard X Millennium Cohort Study Asthma X
Rohrbeck et al., 2016 U.S. active-duty service members X Respiratory Symptoms (ICD-9-CM 786);
Sleep Apnea;
Cancers
Roop et al., 2007 U.S. active-duty Army soldiers X Asthma X
Saers et al., 2017 Swedish military personnel X Respiratory Symptoms (wheeze, wheeze with breathlessness, wheeze without a cold, nocturnal chest tightness, nocturnal breathlessness, nocturnal cough);
Chronic Bronchitis
X
Sharkey et al., 2015 U.S. service members X AFHSC Respiratory Symptoms (ICD-9-CM 786);
Asthma;
COPD;
Acute Bronchitis
X
Sharkey et al., 2016 U.S. service members X AFHSC Respiratory Symptoms (ICD-9-CM 786);
Asthma;
COPD
X
Shorr et al., 2004 U.S. active-duty service members X Interstitial Lung Disease (acute eosinophilic pneumonia) X
Sine et al., 2018 U.S. active-duty service members X Interstitial Lung Disease (acute eosinophilic pneumonia) X
Smith et al., 2008 U.S. active-duty service members X Millennium Cohort Study Sinusitis and Rhinitis;
Sleep Apnea;
Asthma;
Emphysema;
Chronic Bronchitis
Suggested Citation:"Appendix C: Epidemiologic Studies of Respiratory Health Outcomes in Southwest Asia Theater Veterans Newly Reviewed* by the Committee." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
×
Referencea Population 1990–1991 Gulf War Post-9/11 Study Populationb Outcomes Assessedc Smoking Status Collectedd
Smith et al., 2009 U.S. service members, Reserve/National Guard X Millennium Cohort Study Respiratory Symptoms (persistent or recurring cough or shortness of breath);
Asthma;
Emphysema;
Chronic Bronchitis
X
Smith et al., 2012 U.S. service members X Millennium Cohort Study Respiratory Symptoms (persistent or recurring cough or shortness of breath);
Asthma;
Emphysema;
Chronic Bronchitis
X
Soltis et al., 2009 U.S. active-duty service members X Acute Bronchitis
Szema et al., 2010 U.S. veterans X Asthma
Szema et al., 2011 U.S. veterans X Pulmonary Function Testing X
Taylor and Ross, 2019 British active-duty service personnel X Respiratory Symptoms (shortness of breath, wheeze, cough);
Sinusitis and Rhinitis
Weinstein et al., 2016 U.S. active-duty service members X Pulmonary Function Testing
Woods et al., 2018 U.S. active-duty Army personnel Asthma X
Zundel et al., 2019 U.S. veterans X Asthma;
Chronic Bronchitis
X

* “Newly Reviewed” studies are those that have not been addressed in previous National Academies reports.

a Full citations may be found in the References section of Chapter 4.

b Study populations of cohorts that were specified in the Statement of Task are noted.

c Only those outcomes that are addressed in the report are listed. A study may have also addressed other outcomes.

d An “X” indicates that information on smoking was collected, but this does not necessarily mean that it was collected consistently or used in analyses.

NOTE: AFHSC, Armed Forces Health Surveillance Center; AH&OBP, Airborne Hazards and Open Burn Pit; COPD, chronic obstructive pulmonary disease; ICD-9-CM, International Classification of Diseases, 9th edition, Clinical Modification; NewGen, National Health Study for a New Generation of U.S. Veterans; STAMPEDE, Study of Active Duty Military for Pulmonary Disease Related to Environmental Deployment Exposures; TB, tuberculosis; WRIISC, VA War Related Illness and Injury Study Center.

Suggested Citation:"Appendix C: Epidemiologic Studies of Respiratory Health Outcomes in Southwest Asia Theater Veterans Newly Reviewed* by the Committee." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
×
Page243
Suggested Citation:"Appendix C: Epidemiologic Studies of Respiratory Health Outcomes in Southwest Asia Theater Veterans Newly Reviewed* by the Committee." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
×
Page244
Suggested Citation:"Appendix C: Epidemiologic Studies of Respiratory Health Outcomes in Southwest Asia Theater Veterans Newly Reviewed* by the Committee." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
×
Page245
Suggested Citation:"Appendix C: Epidemiologic Studies of Respiratory Health Outcomes in Southwest Asia Theater Veterans Newly Reviewed* by the Committee." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
×
Page246
Suggested Citation:"Appendix C: Epidemiologic Studies of Respiratory Health Outcomes in Southwest Asia Theater Veterans Newly Reviewed* by the Committee." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
×
Page247
Suggested Citation:"Appendix C: Epidemiologic Studies of Respiratory Health Outcomes in Southwest Asia Theater Veterans Newly Reviewed* by the Committee." National Academies of Sciences, Engineering, and Medicine. 2020. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Washington, DC: The National Academies Press. doi: 10.17226/25837.
×
Page248
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More than 3.7 million U.S. service members have participated in operations taking place in the Southwest Asia Theater of Military Operations since 1990. These operations include the 1990-1991 Persian Gulf War, a post-war stabilization period spanning 1992 through September 2001, and the campaigns undertaken in the wake of the September 11, 2001, attacks. Deployment to Iraq, Kuwait, Saudi Arabia, Bahrain, Gulf of Aden, Gulf of Oman, Oman, Qatar, the United Arab Emirates, and Afghanistan exposed service members to a number of airborne hazards, including oil-well fire smoke, emissions from open burn pits, dust and sand suspended in the air, and exhaust from diesel vehicles. The effects of these were compounded by stressors like excessive heat and noise that are inevitable attributes of service in a combat environment.

Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations reviews the scientific evidence regarding respiratory health outcomes in veterans of the Southwest Asia conflicts and identifies research that could feasibly be conducted to address outstanding questions and generate answers, newly emerging technologies that could aid in these efforts, and organizations that the Veterans Administration might partner with to accomplish this work.

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