Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan by Committee on the Long-Term Health Consequences of Exposure to Burn Pits in Iraq & Afghanistan

Author:Committee on the Long-Term Health Consequences of Exposure to Burn Pits in Iraq & Afghanistan
Language: eng
Format: epub
Tags: ebook, book
Publisher: The National Academies Press
Published: 2014-07-16T00:00:00+00:00

Respiratory Disease in OEF/OIF Veterans Exposed to Burn Pits

The DoD report (AFHSC et al. 2010) describing several epidemiologic investigations of health outcomes among military personnel deployed to Iraq and Afghanistan included results on respiratory diseases. The investigators compared incidence rates of diseases and disorders at two military bases in Iraq with burn pits (JBB and Camp Taji) and with four comparison groups (nondeployed personnel in the United States, those deployed to two sites without burn pits in Kuwait [Camps Arifjan and Buehring], and those deployed to Korea). Those potentially exposed to burn pits at JBB or Camp Taji in Iraq consistently showed significantly lower or similar adjusted incidence rate ratios when compared with the nondeployed group. Incidence rate ratios (IRRs) were significantly decreased among personnel deployed to JBB and Taji for respiratory diseases and acute respiratory infections, while estimates were significantly lower in JBB (not significant in Taji) for COPD, asthma, and sleep apnea with all risk estimates for both bases being less than one. However, personnel without exposure to burn pits at Camps Arifjan and Buehring in Kuwait, and at the Korean base had similarly reduced or nonsignificant IRRs, indicating a healthy warrior effect but no disease potentially associated with being deployed to sites with burn pits.

The DoD report also included details of a Millennium Cohort Study analysis that found no significant differences in newly diagnosed asthma, bronchitis, emphysema, or self-reported respiratory symptoms between those deployed to areas within 5 miles of burn pits and those not exposed. No increased risk was noted with increasing cumulative exposure (days) or by camp site. Analyses were adjusted for smoking status, physical activity, and other covariates measured at baseline (AFHSC et al. 2010).

Cases of bronchiolitis have been reported in the media, presumably from exposure to the Mosul sulfur fire in Iraq in 2003 (Bartoo 2010). Constrictive bronchiolitis (CB), also known as bronchiolitis obliterans, is a narrowing of the small airways (the bronchioles) in the lungs. It can be irreversible and can impair daily functioning to the extent that affected individuals are no longer fit for military duty. There are multiple causes, including rheumatoid arthritis, inhalation of toxicants, rejection of a transplanted lung, or it might be idiopathic. It can only be diagnosed by lung biopsy, an invasive procedure that requires a hospital stay, and there is no accepted treatment (King et al. 2008; Bartoo 2010).

Preliminary reports described an unexpected number of CB cases among military personnel who had lung biopsies to determine the cause of their shortness of breath (King et al. 2008; Miller 2009; Bartoo 2010). A total of 38 soldiers were diagnosed with constrictive brochiolitis among 49 who underwent lung biopsy (out of 80 soldiers who had served in Iraq and/or Afghanistan and were referred for respiratory problems). Of the cases, 87% reported exposure while deployed to dust storms, 74% to the 2003 sulfur fire in Mosul, Iraq, and 63% to incinerated waste. Compared to a group of healthy soldiers, the cases were significantly (p < 0.001) older; had a

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