Blast Exposure and Associations With Respiratory Symptoms Among Deployed Military Veterans to Southwest Asia and Afghanistan

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Abstract Rationale: The prevalence of chronic respiratory disease is increased among Veterans returning from deployments to southwest Asia. Blast exposure during military deployment is common and has been proposed as a risk factor for respiratory symptoms. Methods: Using data from the multicenter Veterans Affairs Cooperative Studies Program #595, Service and Health Among Deployed Veterans (SHADE), we examined the association between blast exposures during deployment and respiratory symptoms post-deployment. Participants were randomly selected from deployment roster records and characteristics were measured at enrollment into the cohort. Blast exposure from an improvised explosive device or other explosion was self-reported using a coordinator-administered survey that included blast proximity (<30 feet) and an estimate of blast exposure frequency. Chronic bronchitis, wheeze (in the past 12 months), and dyspnea (other than with heavy exertion) were defined by established questionnaire items. Occupational and environmental deployment-related exposure to burn pits and vapor, gas, dusts, and fumes (VGDF) were quantified through a validated instrument. After adjusting for potential confounders including age, sex, race (black, white, other), and body mass index, we used multivariable hierarchical logistic models with Kenward-Roger degrees of freedom estimation to estimate the associations between blast exposure and respiratory symptoms. We created additional models including smoking status (current, former, never) and deployment-related exposures domains with known association with respiratory symptoms (burn pits and VGDF). Results: Of the 1,958 study participants, 88% were male and 963 (49.2%) reported being exposed to blasts during their deployment. 65% were <30 ft and the median frequency of blast exposure was 3 (IQR 1 to 10). Respiratory symptoms were assessed a mean (SD) 10.1 (3.6) years post-deployment. Compared to participants without any blast exposure, those with blast exposure were more frequently male, in the Army (vs. Marines or Air Force) and had longer duration of deployment. After adjusting for demographic and smoking, blast exposure was statistically significantly associated with increased odds of dyspnea, but not wheeze or chronic bronchitis (Table). After further adjustment for burn pit and VGDF exposures, the odds of dyspnea were attenuated (OR 1.46; 95% CI: 0.97 to 2.19). Conclusions: Self-reported blast exposures were highly prevalent and associated with dyspnea, however the association was attenuated after adjusting for selected deployment-related occupational/environmental exposures. Our results suggest that comprehensive assessment of exposures is needed to assess health effects after blast exposures, including possible effects of co-exposures.

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