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News Release | September 11, 2020

By: The National Academies of Sciences Engineering Medicine

WASHINGTON — Limitations in existing health studies have resulted in insufficient evidence to determine whether U.S. troops’ exposure to burn pit emissions and other airborne hazards in Southwest Asia are linked to adverse respiratory health outcomes, says a new report from the National Academies of Sciences, Engineering, and Medicine. Through partnerships with other agencies, and the use of emerging exposure assessment technologies, the U.S. Department of Veterans Affairs (VA) could conduct or support well-designed studies that would yield more definitive answers.

Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations reviewed 27 respiratory health outcomes, including respiratory cancers, asthma, chronic bronchitis, sinusitis, and constrictive bronchiolitis. Of these 27 outcomes, none met the criteria for sufficient evidence of an association with service in the Southwest Asia theater, which comprises the Persian Gulf countries and Afghanistan. The evidence for respiratory symptoms — which included chronic persistent cough, shortness of breath, and wheezing — met the criteria for limited or suggestive evidence of an association for both veterans who served in the 1990-1991 Persian Gulf War and those who served in the military operations after the Sept. 11, 2001, attacks.

“New approaches are needed to better answer whether respiratory health issues are associated with deployment. The current uncertainty should not be interpreted as meaning that there is no association — rather, the issue is that the available data are of insufficient quality to draw definitive conclusions,” said Mark Utell, a physician and professor of medicine and environmental medicine at the University of Rochester Medical Center, and chair of the committee that wrote the report. “However, the committee believes it is possible today to conduct well-designed studies that will provide more clarity to veterans who are seeking to understand the respiratory problems they are experiencing.”

More than 3.7 million U.S. service members have served in the Southwest Asia theater of military operations since 1990. These operations include the 1990-1991 Persian Gulf War, a post-war stabilization period (1992-2001), and the post-9/11 conflicts. Deployment to the region exposed service members to airborne hazards including oil-well fire smoke, emissions from open burn pits, dust suspended in the air, exhaust from military vehicles, and local industrial emissions. Temperature extremes, stress, and noise encountered by service members may have increased their vulnerability to these exposures.

Existing studies on respiratory health and deployment to Southwest Asia have a number of limitations, says the report. For example, many studies implicitly assume that deployed veterans had the same exposures to airborne hazards, overlooking that burn pit emissions and other pollutants differed by conflict and varied by location and over time. Several studies failed to adequately account for cigarette smoking — a known cause of respiratory health problems — in their analyses of outcomes. Further, mortality reports have not consistently broken out deaths from respiratory disease, making it difficult to assess the extent of harm caused by airborne exposures.

Addressing Knowledge Gaps

The committee observed that there are several ways to address the knowledge gaps they found. To identify subpopulations that may be susceptible to respiratory health problems, future studies of theater veterans should evaluate how factors such as race, gender, and the location and timing of deployments and military service could modify the effects of airborne exposures.

Deployed service members are often at the peak of their lung function, which occurs in their early 20s, the report notes. The effects of exposures, including burn pits, related to deployment may take time to manifest. Longitudinal studies are therefore needed to record baseline lung function and examine changes over time. Other retrospective studies can feasibly be done using imaging and biomarkers.

The report also recommends that VA conduct an updated analysis of mortality among Southwest Asia theater veterans, since the last analysis was done in 2011. Future mortality studies should compare veterans exposed to higher and lower levels of airborne agents, rather than comparing all veterans to the general population.

Potential Partners for VA

VA already partners extensively with the U.S. Department of Defense (DOD), and the two agencies have been working toward a modernized and interoperable electronic health record system that is expected to roll out in late 2020. As part of this effort, VA and DOD should explicitly integrate research access considerations into the planning and implementation of their electronic health record system. They should exchange information on exposures that personnel encounter during military service; and their impact on health before, during, and after deployment and after transition to veteran status.

Other agencies hold data and manage technologies that could aid in the VA’s research efforts. They include NASA, the National Oceanic and Atmospheric Administration, and the National Institute for Occupational Safety and Health.

Emerging Technologies to Aid Future Research

The report also identifies several emerging technologies that could address knowledge gaps. New discoveries in biomarkers — characteristics of the body that can be measured — could provide more information on environmental exposures, effects, and susceptibility. Recent advances in the analysis of satellite data may also enable more accurate estimates of past airborne pollutants levels and burn pit emissions. Other potential technologies include silicone wristbands for exposure detection; low-cost wearable devices that measure changes in health in real time; and, further in the future, portable “readers” that could map changes to the human genome resulting from certain hazardous exposures.

The study — undertaken by the Committee on the Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations — was sponsored by the U.S. Department of Veterans Affairs. The National Academies are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln. 

Contact:
Stephanie Miceli, Media Officer
Office of News and Public Information
202-334-2138; e-mail news@nas.edu