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Chronic respiratory symptoms following deployment-related occupational and environmental exposures among US veterans
  1. Eric Garshick1,2,
  2. Carrie A Redlich3,
  3. Anna Korpak4,
  4. Andrew K Timmons4,
  5. Nicholas L Smith4,5,
  6. Karen Nakayama4,
  7. Coleen P Baird6,
  8. Paul Ciminera7,
  9. Farrah Kheradmand8,9,
  10. Vincent S Fan10,11,
  11. Jaime E Hart2,12,
  12. Petros Koutrakis12,
  13. Ware Kuschner13,14,
  14. Octavian Ioachimescu15,16,
  15. Michael Jerrett17,
  16. Phillipe R Montgrain18,19,
  17. Susan P Proctor20,21,
  18. Emily S Wan1,2,
  19. Christine H Wendt22,23,
  20. Cherry Wongtrakool24,25,
  21. Paul D Blanc26,27
  1. 1 Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, West Roxbury, Massachusetts, USA
  2. 2 Harvard Medical School, Brigham and Women's Hospital Channing Division of Network Medicine, Boston, Massachusetts, USA
  3. 3 Occupational and Environmental Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
  4. 4 Seattle Epidemiologic Research and Information Center, Department of Veteran Affairs Office of Research and Development, VA Puget Sound Health Care System Seattle Division, Seattle, Washington, USA
  5. 5 Department of Epidemiology, University of Washington, Seattle, Washington, USA
  6. 6 Medical Science Affiliates, Columbia, Maryland, USA
  7. 7 Health Services Policy and Oversight, Office of the Assistant Secretary of Defense for Health Affairs, Washington, District of Columbia, USA
  8. 8 Department of Medicine, Michael E DeBakey VA Medical Center, Houston, Texas, USA
  9. 9 Baylor College of Medicine, Houston, Texas, USA
  10. 10 VA Puget Sound HCS Seattle Division, Seattle, Washington, USA
  11. 11 Department of Medicine, University of Washington, Seattle, Washington, USA
  12. 12 Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
  13. 13 VA Palo Alto Health Care System, Palo Alto, California, USA
  14. 14 Stanford University School of Medicine, Stanford, California, USA
  15. 15 Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin, USA
  16. 16 Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  17. 17 University of California Los Angeles Jonathan and Karin Fielding School of Public Health, Los Angeles, California, USA
  18. 18 VA San Diego Healthcare System, San Diego, California, USA
  19. 19 Department of Medicine, University of California San Diego, San Diego, California, USA
  20. 20 US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
  21. 21 Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
  22. 22 Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Medical Center, Minneapolis, Minnesota, USA
  23. 23 University of Minnesota, Minneapolis, Minnesota, USA
  24. 24 Atlanta VA Medical Center, Decatur, Georgia, USA
  25. 25 Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
  26. 26 San Francisco VA Health Care System, San Francisco, California, USA
  27. 27 Division of Occupational, Environmental, and Climate Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Eric Garshick, Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, West Roxbury, Massachusetts, USA; eric.garshick{at}


Objectives Characterise inhalational exposures during deployment to Afghanistan and Southwest Asia and associations with postdeployment respiratory symptoms.

Methods Participants (n=1960) in this cross-sectional study of US Veterans (Veterans Affairs Cooperative Study ‘Service and Health Among Deployed Veterans’) completed an interviewer-administered questionnaire regarding 32 deployment exposures, grouped a priori into six categories: burn pit smoke; other combustion sources; engine exhaust; mechanical and desert dusts; toxicants; and military job-related vapours gas, dusts or fumes (VGDF). Responses were scored ordinally (0, 1, 2) according to exposure frequency. Factor analysis supported item reduction and category consolidation yielding 28 exposure items in 5 categories. Generalised linear models with a logit link tested associations with symptoms (by respiratory health questionnaire) adjusting for other covariates. OR were scaled per 20-point score increment (normalised maximum=100).

Results The cohort mean age was 40.7 years with a median deployment duration of 11.7 months. Heavy exposures to multiple inhalational exposures were commonly reported, including burn pit smoke (72.7%) and VGDF (72.0%). The prevalence of dyspnoea, chronic bronchitis and wheeze in the past 12 months was 7.3%, 8.2% and 15.6%, respectively. Burn pit smoke exposure was associated with dyspnoea (OR 1.22; 95% CI 1.06 to 1.47) and chronic bronchitis (OR 1.22; 95% CI 1.13 to 1.44). Exposure to VGDF was associated with dyspnoea (OR 1.29; 95% CI 1.14 to 1.58) and wheeze (OR 1.18; 95% CI 1.02 to 1.35).

Conclusion Exposures to burn pit smoke and military occupational VGDF during deployment were associated with an increased odds of chronic respiratory symptoms among US Veterans.

  • occupational health
  • air pollution
  • respiratory system

Data availability statement

Data are available on reasonable request. Deidentified data are available for approved investigators with IRB and institutional approval.

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Data availability statement

Data are available on reasonable request. Deidentified data are available for approved investigators with IRB and institutional approval.

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  • Contributors EG, PDB and SPP designed the data collection tools. AK, AKT, NLS and KN monitored data collection and implemented the study together with EG and PDB who are the guarantors. PDB and EG designed the analysis plan, and AK conducted the statistical analysis with the assistance of AKT. FK, VSF, OI, PRM, ESW, CHW and CW supervised study data collection. JEH, PK and MJ contributed to study design. CAR, CPB, PC, WK and JEH contributed to data analysis and interpretation. EG and PDB drafted the paper and revised the draft paper with the contribution of CAR and AK. All authors approved the final manuscript.

  • Funding US Department of Veterans Affairs; Veterans Affairs Cooperative Studies Program #595: Pulmonary Health and Deployment to Southwest Asia and Afghanistan, also known as SHADE (Service and Health Among Deployed Veterans) from the Office of Research and Development, Clinical Science Research and Development, Cooperative Studies Program. The contents do not represent the views of the US Department of Veterans Affairs or the US Government.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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