Blast exposure predicts respiratory symptoms in veterans

Self-reported blast exposure predicted respiratory symptoms and COPD among post 9/11 veterans who were deployed to Southwest Asia and Afghanistan, according to results published in Respiratory Medicine.

Moreover, the greater the severity of blast exposure, the more likely veterans were to report adverse respiratory outcomes.

“Blast lung injury is usually acute and diagnosed at time of injury. Estimates from U.S. and U.K. military registries show that 11% of in-theater trauma injuries were from blast lung, and that among all those with primary blast injuries, 30% had lung involvement,” Stella E. Hines, MD, MSPH, assistant professor in the division of occupational and environmental medicine at the University of Maryland School of Medicine, and colleagues wrote.

The study included 2,147 veterans from the Department of Veterans Affairs Toxic Embedded Fragment Registry who completed a survey regarding chronic respiratory symptoms, diagnoses and exposures. Most participants were younger than 40 years, served in the Army and were injured an average of 12.8 years prior. Researchers assessed blast exposure in all participants using the Brief Traumatic Brain Injury Screen and presence of other symptoms, including blast-induced loss of consciousness.

Overall, 91% of participants self-reported blast exposure. Researchers reported a significantly higher likelihood of cough (OR = 1.8; 95% CI, 1.3-2.5), wheeze (OR = 2.5; 95% CI, 1.8-3.5) and dyspnea (OR = 1.8; 95% CI, 1.2-2.6) among blast-exposed veterans, even after adjustment for covariates such as smoking and occupational exposures to dust, fume and gas.

Veterans who reported a higher severity of blast impact (7.7%), including traumatic brain injury or loss of consciousness, were also more likely to report cough (OR = 2.2; 95% CI, 1.5-3.3), wheeze (OR = 2.3; 95% CI, 1.6-3.5) or dyspnea (OR = 4.4; 95% CI, 2.9-6.7), the researchers wrote. Those with higher blast impact severity by multiple measures also had a higher likelihood of reporting COPD (OR = 1.2; 95% CI, 0.6-2.2).

In addition, veterans who reported physician-diagnosed traumatic brain injury had a significantly higher likelihood of reporting asthma (OR = 1.5; 95% CI, 1-2.1) and COPD (OR = 1.5; 95% CI, 1-2.1), according to the results.

“Future studies should further investigate mechanistic hypotheses for chronic lung injury from pulmonary barotrauma,” the researchers wrote. “Further, respiratory system evaluation may warrant inclusion as a standard part of barotrauma health assessment.”