Environmental Exposures and Asthma in Active Duty Service Members
Purpose of Review
Reports of respiratory symptoms, including asthma and hyper-reactive airway disease, have been more numerous in the media and medical literature since active duty service members (SM) began to support campaigns in South West Asia (SWA). Numerous environmental exposures have been reported and this review assesses the available evidence surrounding exposures, confounding conditions, and attempts to develop screening mechanisms.
While particulate matter exposures and particularly exposure to burn pits have garnered much attention, a 2010 Armed Forces Health Surveillance Center report and 2011 Institute of Medicine publication did not identify a link between exposure to particulate matter with SM respiratory disease. The “Study of Active Duty Military for Pulmonary Disease related to Environmental Deployment Exposure,” (STAMPEDE) and STAMPEDE II have not identified effective forms of routine screening and these and other sources point to the importance of other factors in SM respiratory disease. These include higher than anticipated rates of tobacco use in deployed settings, impacts of obesity, recurrence of childhood asthma, and of confounding conditions such as Paradoxical Vocal Fold Motion.
As with the general population, a complex set of clinical inputs and environmental exposures surround asthma and similar respiratory processes in SM. Concrete relationships and mechanisms for assessment continue to be assessed and refined, but clear associations and pathways have remained elusive.
KeywordsAsthma Burn pit Paradoxical vocal fold motion Vocal cord dysfunction Deployment-associated lung disease Environmental exposure Hypersensitivity Military
Global War on Terrorism
Improvised explosive device
Paradoxical vocal fold motion
South West Asia
Compliance with Ethical Standards
Conflict of Interest
The views expressed in this article are those of the authors and do not reflect the official policy of the Department of Army, Navy, Department of Defense, or US Government.
I am a military service member. This work was prepared as part of my official duties. Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person’s official duties.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.•• Morris MJ, Skabelund AJ, Rawlins FA 3rd, et al. Study of active duty military personnel for environmental deployment exposures: pre- and post-deployment spirometry (STAMPEDE II). Respir Care. 2019;64(5):536–44 Large, recent study evaluating potential screening mechanisms for pre-/post-deployment service members.CrossRefGoogle Scholar
- 7.Armed Forces Health Surveillance Center. Epidemiological studies of health outcomes among troops deployed to burn pit sites. MD: Silver Spring; 2010.Google Scholar
- 8.• Institute of Medicine. Long-term health consequences of exposure to burn pits in Iraq and Afghanistan. Washington, DC: The National Academies Press; 2011. Robust investigation of possible links between PM and burn pit exposure and respiratory symptoms, did not identify an association. Google Scholar
- 9.Morris MJ, Rawlins FA, Forbes DA et al. Deployment-related respiratory issues. US Army Med Dep J 2016. 173–178.Google Scholar
- 10.•• Morris MJ, Dodson DW, Lucero PF, et al. Study of active duty military for pulmonary disease related to environmental deployment exposures (STAMPEDE). Am J Respir Crit Care Med. 2014;190(1):77–84 Significant initial work regarding rigorous assessment of respiratory symptoms in service members returning from deployment. CrossRefGoogle Scholar
- 28.National Wildfire Coordinating Group. Wildland Fire Safety. Available online at: https://www.nwcg.gov/publications/training-courses/rt-130/hazards/haz508 ; last accessed June 13, 2019.
- 35.Centers for Disease Control and Prevention. Current cigarette smoking among adults in the U.S. Available online at: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm ; last accessed June 13, 2019.
- 36.Centers for Disease Control and Prevention. Burden of tobacco use in the U.S. Available online at: https://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united-states.html; last accessed June 13, 2019.