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National Academies publishes a report on respiratory health effects of airborne hazards

Military Exposures & Your Health: Information for Veterans who servedthe gulf war era and their families

The National Academies of Sciences, Engineering, and Medicine (NASEM) examined the scientific findings from studies on the respiratory health effects of airborne hazards during deployment and published a report about them called The Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations on September 11, 2020. This report is a follow-on to a report published in 2011 titled Long-Term Consequences of Exposure to Burn Pits in Iraq and Afghanistan. One of the key conclusions in the 2020 report was that particulate matter from regional sources was of potential importance. NASEM recommended expanding research studies to explore the role of a broader range of possible airborne hazards beyond burn pits. This includes sand and dust, local air pollution, fuels, and other possible breathing hazards. 

A NASEM committee reviewed 27 different respiratory symptoms and diseases. They used four categories of association (sufficient evidence of an association, limited or suggestive evidence of an association, inadequate or insufficient evidence to determine an association, and limited or suggestive evidence of no association) to rate the strength of the scientific evidence. The committee concluded that respiratory symptoms had limited or suggestive evidence of an association with airborne hazards, while the other categories of health outcomes had inadequate or insufficient evidence to determine an association. These findings do not mean that there is no association between deployment to the Southwest Asia theater and the respiratory health outcomes in this category, but instead that the available evidence does not allow a more definitive determination to be made about a potential association.

Many of the studies on these conditions were weakened by bias due to self-selection of the participants, self-reported outcomes and exposures and/or lack of control for lifestyle factors that can impact health, such as cigarette smoking. The committee also noted a lack of exposure characterization as a major reason why associations could not be evaluated. Finally, deployment to the 1990–1991 Gulf War and changes in lung function was determined to have limited or suggestive evidence of no association.  

The committee recommended that VA and the Department of Defense continue to work together on environmental health issues, including sharing information on military exposures and working to understand the health of personnel before, during, and after service.    

NASEM findings on health effects

Limited or suggestive evidence of an association

  • Respiratory symptoms – Shortness of breath (dyspnea), chronic persistent cough, wheeze

 Inadequate or insufficient evidence to determine an association

  • Changes in pulmonary function
  • Mortality due to diseases of the respiratory system
  • Infectious lower airway (Acute bronchitis, pneumonia, tuberculosis)
  • Upper airway disorders – Rhinitis, sinusitis, sleep apnea, vocal cord dysfunction
  • Non- infectious lower airway – Asthma, chronic bronchitis, constructive bronchiolitis, chronic obstructive pulmonary disease, emphysema
  • Interstitial lung disease – Acute eosinophilic pneumonia, hypersensitivity pneumonitis, idiopathic interstitial pneumonia, idiopathic pulmonary fibrosis, sarcoidosis
  • Respiratory cancers – Esophageal, laryngeal, lung, oral, nasal, pharyngeal


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