Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations (2020)
Chapter: Front Matter
Respiratory
Health Effects of
Airborne Hazards Exposures
in the Southwest Asia
Theater of Military
Operations
Committee on the Respiratory Health Effects of
Airborne Hazards Exposures in the
Southwest Asia Theater of Military Operations
Board on Population Health and Public Health Practice
Health and Medicine Division
A Consensus Study Report of
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by Contract Order No. 36C24E18C0068 between the National Academy of Sciences and the Department of Veterans Affairs. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-67910-7
International Standard Book Number-10: 0-309-67910-9
Digital Object Identifier: https://doi.org/10.17226/25837
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Suggested citation: 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. https://doi.org/10.17226/25837.
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COMMITTEE ON THE RESPIRATORY HEALTH EFFECTS OF AIRBORNE HAZARDS EXPOSURES IN THE SOUTHWEST ASIA THEATER OF MILITARY OPERATIONS
MARK J. UTELL (Chair), Professor of Medicine and Environmental Medicine, Director of Occupational and Environmental Medicine, former Director of Pulmonary and Critical Care Medicine, University of Rochester Medical Center
LUNG-CHI CHEN, Professor, Department of Environmental Medicine, New York University Grossman School of Medicine
ELLEN A. EISEN, Professor, School of Public Health, University of California, Berkeley
MEREDITH FRANKLIN, Associate Professor, Division of Biostatistics, Keck School of Medicine, University of Southern California; Director of MS Programs in Biostatistics, Health Data Sciences, and Epidemiology
KIRK D. JONES, Clinical Professor, University of California, San Francisco
MEREDITH C. MccORMAcK, Associate Professor of Medicine and Medical Director, Pulmonary Function Laboratory, Johns Hopkins University; Vice Chair, American Thoracic Society Committee for Proficiency Standards in Pulmonary Function Testing
CECILE S. ROSE, Professor of Medicine, National Jewish Health, Division of Environmental and Occupational Health Sciences, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine
FRANK E. SPEIZER, Professor of Environmental Science, Harvard T.H. Chan School of Public Health, Edward H. Kass Distinguished Professor of Medicine, Harvard Medical School ELAINE SYMANSKI, Professor, Center for Precision Environment Health, Department of Medicine, Baylor College of Medicine SVERRE VEDAL, Professor Emeritus, Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington
JODY WIREMAN, Environmental Health Advisor, Defense Health Agency
Study Staff
DAVID A. BUTLER, Scholar and Study Director
ELIZABETH BARKSDALE BOYLE, Program Officer
CHRISTINA R. SAMUEL, Research Associate
REBECCA F. CHEVAT, Senior Program Assistant
ANNE N. STYKA, Senior Program Officer
KRISTIN E. WHITE, Associate Program Officer
ROSE MARIE MARTINEZ, Senior Director, Board on Population Health and Public Health Practice
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Reviewers
This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.
We thank the following individuals for their review of this report:
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report, nor did they see the final draft before its release. The review of this report was overseen by SANDRO GALEA, Boston University School of Public Health, and DAVID A. SAVITZ, Brown University. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.
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Acknowledgments
The committee could not have written this report without the help of a number of people. We wish to particularly thank the presenters and participants in our October 2019 workshop—listed in Appendix A—who shared their expertise and perspectives on respiratory health issues in veterans and the research that might allow a better understanding of them. Drs. R. Loren Erickson and Eric Shuping of the Department of Veterans Affairs also briefed the committee and responded to our follow-up questions.
The committee members are very appreciative of the outstanding efforts of the staff of the National Academies of Sciences, Engineering, and Medicine’s Health and Medicine Division, who supported us in our work, David Butler, who served as study director; and Elizabeth Boyle, Christina Samuel, Anne Styka, Kristin White, and Stephanie Hanson, who had a daunting task of identifying and culling the large and complex literature we reviewed and more generally guiding and assisting the committee in its mission. We are also very grateful to Rebecca Chevat for capably providing logistical support. Finally, we would like to acknowledge Jorge Mendoza, a senior research librarian who conducted the literature searches for the committee, and Misrak Dabi, the financial business partner for the project.
Mark J. Utell, Chair
Committee on the Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations
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Contents
U.S. Deployments to the Southwest Asia Theater
Aftermath of Southwest Asia Theater Deployment
Committee’s Approach to Its Charge
2 AIRBORNE HAZARDS IN SOUTHWEST ASIA
Exposures Associated with Military Operations in the Southwest Asia Theater
Regional Environmental Exposures
Exposure Tracking by the Department of Defense
Factors That May Lead to Increased Vulnerability to Airborne Hazards
Final Observations on Airborne Hazards
3 EVALUATION OF THE EVIDENCE BASE AND BACKGROUND OF MAJOR STUDIES AND COHORTS
Identification and Screening of Literature
4 EVALUATION OF RESPIRATORY OUTCOMES
Issues Identified for the Committee’s Attention
Hazards Associated with Burn Pit Exposures
Research That Could Feasibly Be Conducted
Newly Emerging Technologies to Address Knowledge Gaps
Organizations That the Department of Veterans Affairs Might Partner with to Address Knowledge Gaps
B NATIONAL ACADEMIES REPORTS RELATED TO GULF THEATER VETERANS’ HEALTH
Acronyms and Abbreviations
| AEP | acute eosinophilic pneumonia |
| AFRL | Air Force Research Laboratory |
| AH&OBP | Airborne Hazards and Open Burn Pit |
| AHBPCE | VA Airborne Hazards and Burn Pits Center of Excellence |
| AHCE | Airborne Hazards Center of Excellence |
| ARDS | acute respiratory distress syndrome |
| ATS | American Thoracic Society |
| BALF | bronchoalveolar lavage fluid |
| BMI | body mass index |
| CARC | chemical agent resistant coating |
| CBRNE | Chemical, Biological, Radiological, Nuclear, and high yield Explosives |
| CDC | Centers for Disease Control and Prevention |
| CDMRP | Congressionally Directed Medical Research Programs |
| CHAI | Comparative Health Assessment Interview |
| CHPPM | U.S. Army Center for Health Promotion and Preventive Medicine |
| CI | confidence interval |
| CMS | Centers for Medicare & Medicaid Services |
| COPD | chronic obstructive pulmonary disease |
| CT | computed tomography |
| DARPA | Defense Advanced Research Projects Agency |
| DECAMP | Detection of Early Lung Cancer Among Military Personnel |
| DHA | Defense Health Agency |
| DHB | Defense Health Board |
| DL/VA | the ratio of DLCO to alveolar volume |
| DLCO | diffusing capacity of the lung to carbon monoxide |
| DMDC | Defense Manpower Data Center |
| DMSS | Defense Medical Surveillance System |
| DoD | Department of Defense |
| DoDSR | Department of Defense Serum Repository |
| DOEHRS-IH | Defense Occupational and Environmental Health Readiness System–Industrial Hygiene |
| DSRR | directly standardized relative risk |
| DU | depleted uranium |
| ECG | electrocardiogram |
| ECRHS | European Community Respiratory Health Survey |
| EHR | electronic health record |
| EPA | Environmental Protection Agency |
| EPMSP | Enhanced Particulate Matter Surveillance Program |
| ERS | European Respiratory Society |
| ESA | European Space Agency |
| FEF | forced expiratory flow |
| FEV | forced expiratory volume |
| FEV1 | forced expiratory volume in 1 second |
| FOT | forced oscillation technique |
| FRC | functional residual capacity |
| FVC | forced vital capacity |
| GINA | Global Initiative for Asthma |
| GM-CSF | granulocyte-macrophage colony-stimulating factor |
| GOLD | Global Initiative for Chronic Obstructive Lung Disease |
| HR | hazard ratio |
| HYSPLIT | Hybrid Single Particle Lagrangian Integrated Trajectory |
| ICD-9-CM | International Classification of Diseases, Ninth Edition, Clinical Modification |
| IgA | immunoglobulin A |
| IIP | idiopathic interstitial pneumonia |
| ILER | Individual Longitudinal Exposure Record |
| IOM | Institute of Medicine |
| IOS | impulse oscillometry |
| IPF | idiopathic pulmonary fibrosis |
| IR | incidence rate |
| IRB | institutional review board |
| IRR | incidence rate ratio |
| JPC | Joint Pathology Center |
| LCI | lung clearance index |
| LLN | lower limit of normal |
| LTBI | latent tuberculosis infection |
| MAIA | Multi-Angle Imager for Aerosols |
| MeSH | medical subject heading |
| miRNA | micro RNA |
| MISR | Multi-angle Imaging SpectroRadiometer |
| MODIS | Moderate Resolution Imaging Spectroradiometer |
| MOS | military occupational specialty |
| MRE | meals, ready-to-eat |
| MRR | mortality rate ratio |
| n | population size |
| NAAQS | National Ambient Air Quality Standards |
| NAS | National Academy of Sciences |
| NASA | National Aeronautics and Space Administration |
| n.d. | no date |
| NewGen | National Health Study for a New Generation of U.S. Veterans |
| NF-κB | nuclear factor kappa B |
| NHANES | National Health and Nutrition Examination Survey |
| NHLBI | National Heart, Lung, and Blood Institute |
| NHS | National Health Survey of Gulf War Veterans and Their Families |
| NIEHS | National Institute of Environmental Health Sciences |
| NIH | National Institutes of Health |
| NIOSH | National Institute for Occupational Safety and Health |
| NOAA | National Oceanic and Atmospheric Administration |
| NRC | National Research Council |
| OEF | Operation Enduring Freedom |
| OIF | Operation Iraqi Freedom |
| OMI | Ozone Mapping Instrument |
| OND | Operation New Dawn |
| OR | odds ratio |
| p | p-value |
| PAH | polycyclic aromatic hydrocarbon |
| PAP | pulmonary alveolar proteinosis |
| PCB | polychlorinated biphenyl |
| PCDD/F | polychlorinated dibenzo-p-dioxin and dibenzo-p-furan |
| portable document format | |
| PET | positron emission tomography |
| PFT | pulmonary function test |
| pIgR | polymeric immunoglobulin receptor |
| PIR | proportional incidence ratio |
| PL | Public Law |
| PM | particulate matter |
| POEMS | periodic occupational and environmental monitoring summary |
| PTSD | posttraumatic stress disorder |
| RAC | Research Advisory Committee on Gulf War Veterans’ Illnesses |
| Raw | airways resistance |
| RD | rate difference |
| RFI | request for information |
| RR | rate ratio |
| RV | residual volume |
| SHADE | Service and Health Among Deployed Veterans |
| SIR | standardized incidence ratio |
| SMR | standardized mortality ratio |
| SPIROLA | Spirometry Longitudinal Data Analysis |
| SSIC | signs, symptoms, and ill-defined conditions |
| STAMPEDE | Study of Active Duty Military for Pulmonary Disease Related to Environmental Deployment Exposures |
| TB | tuberculosis |
| TBI | traumatic brain injury |
| TLC | total lung capacity |
| TSP | total suspended particles |
| VA | Department of Veterans Affairs |
| VHA | Veterans Health Administration |
| VO2 | volume of oxygen (O2) |
| VOC | volatile organic compound |
| WHO | World Health Organization |
| WRIISC | VA War Related Illness and Injury Study Center |
