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Military small arms fire in association with acute decrements in lung function
  1. Anne Katrine Borander1,2,
  2. Øyvind Albert Voie3,
  3. Kjetil Longva3,
  4. Tor Erik Danielsen1,
  5. Svein Grahnstedt1,
  6. Leiv Sandvik4,5,
  7. Johny Kongerud5,6,
  8. Liv Ingunn Bjoner Sikkeland5,6
  1. 1 Department of Environmental and Occupational Medicine, Oslo University Hospital, Ullevål, Oslo, Norway
  2. 2 Occupational Health Service, Sessvollmoen, Norwegian Armed Forces, Oslo, Norway
  3. 3 Division Protection and Societal Security, Norwegian Defence Research Establishment, Kjeller, Norway
  4. 4 Department of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
  5. 5 Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
  6. 6 Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
  1. Correspondence to Liv Ingunn Bjoner Sikkeland, Department of Respiratory Medicine, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway, Nydalen, Oslo 0424, Norway; l.i.b.sikkeland{at}


Objective After introduction of unleaded ammunition, Norwegian Armed Forces received reports of acute respiratory symptoms in soldiers after exposure to fumes from firing the standard weapon, HK416. The aim of the present study was to examine lung function before and after exposure to fumes from HK416 in a double-blinded standardised study design using three different types of ammunition.

Methods Fifty-four healthy, non-smoking male volunteers (19–62 years) fired the weapons for 60 min with either leaded, unleaded or ‘modified’ unleaded ammunition. Gaseous and particulate emissions were monitored. Spirometry and exhaled nitric oxide (eNO) were performed within 14 days before (T0), shortly after (T1) and 24 hours after (T2) shooting. Methacholine provocation and diffusing capacity of carbon monoxide (DLCO) were carried out at T0 and T2.

Results The mean forced expiratory volume in 1 s on a group level was significantly reduced both at T1 and T2 compared with T0, with means and 95% CI of 226 mL (158 to 294 mL) and 285 mL (218 to 351 mL), respectively. The same significant pattern was seen for DLCO, forced vital capacity and eNO. The methacholine test indicated a slight increase in bronchial hyper-reactivity. However, there were no significant differences between types of ammunition used.

Conclusion Exposure to fumes from military weapons might be a respiratory hazard for soldiers who do live-fire training regularly or are in a closed combat environment.

  • Respiratory
  • Lung function
  • Dusts
  • Metals
  • Occupational exposure

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  • Contributors All authors contributed to the design of the study, to interpretation of the results and in revising the manuscript. AKB, LIBS and AV participated in data collection. LS is a statistician and did the statistical analysis. AKB drafted the manuscript in collaboration with JK, AV and LIBS. The final version has been approved by all authors.

  • Competing interests JK reports non-personal fee from Boehringer Ingelheim, personal fees from Norwegian Asthma and Allergy Association (NAAF), outside the submitted work. LIBS reports grants from Bohringer Ingelheim, outside the submitted work.

  • Ethics approval Regional Ethical Committee, South East (RECno.2011/1335b).

  • Provenance and peer review Not commissioned; externally peer reviewed.