Postdeployment Respiratory Health Care Encounters Following Deployment to Kabul, Afghanistan: A Retrospective Cohort Study

Abstract

Inhalational hazards are numerous in operational environments. A retrospective cohort study was conducted to investigate associations between deployment to Kabul, Afghanistan and subsequent respiratory health among U.S. military personnel. The study population consisted of personnel who deployed to Kabul, select Operation Enduring Freedom locations, personnel stationed in the Republic of Korea, and U.S.-stationed personnel. Incidence rate ratios (IRRs) were estimated for respiratory symptoms, signs, and ill-defined conditions, asthma, and chronic obstructive pulmonary disease. A significantly elevated rate of symptoms, signs, and ill-defined conditions was observed among Kabul-deployed personnel compared to personnel deployed or stationed in Bagram (IRR 1.12; 95% confidence interval [CI], 1.05-1.19), Republic of Korea (IRR 1.20; 95% CI, 1.10-1.31), and the United States (IRR 1.52; 95% CI, 1.43-1.62). A statistically elevated rate of asthma was observed among personnel deployed to Kabul, relative to U.S.-stationed personnel (IRR 1.61; 95% CI, 1.22-2.12). Statistically significant rates were not observed for chronic obstructive pulmonary disease among Kabul-deployed personnel compared to other study groups. These findings suggest that deployment to Kabul is associated with an elevated risk of postdeployment respiratory symptoms and new-onset asthma.

Combat zone exposure and respiratory tract disease

“…Up to 69% of soldiers have been affected to some degree by respiratory ailments, with asthma being the most commonly reported new respiratory diagnosis in the literature . Most reports have suggested a correlation exists between deployment and reversible obstructive disease, whereas others showed no increase in risk . Among veterans with recent deployment to Iraq and/or Afghanistan, Szema et al demonstrated a significantly increased rate of respiratory symptoms and changes in pulmonary function compared with soldiers stateside .…”

Fumes and faeces in Kabul

“…Site survey data from multiple nations conclude that air quality in Kabul City is poor and this has an impact on the health of our SP 1 2 6. The data from this study appear to correlate trends in respiratory illness with worsening air quality.…”

“…The potential for causing health problems is directly linked to the size of the particles. The unanimous conclusion by the US and UK military environmental health teams is that PM levels (PM 10 micrometres and PM 2.5 micrometres) in Kabul are significantly elevated,2 compared with the WHO and European Union air quality guidelines for PM.…”

“…Multiple environmental survey reports by several international agencies including the US and British Army environmental health teams in Kabul1 2 5 dating as far back as 2003 demonstrate poor air quality. An environmental health report from one of the main UK military locations (conducted in December 2014 at the Toral Aviation Detachment located in Taipan) concluded air quality is poor in all areas of Kabul and is a known health risk.…”

Bronchodilator Responsiveness and Airflow Limitation Are Associated With Deployment Length in Iraq and Afghanistan Veterans

“…Our findings are consistent with epidemiological studies in the active duty population that found an increased risk of respiratory conditions, specifically asthma, in personnel deployed to Iraq 17 or Afghanistan. 29 In addition, the present findings suggest that clinicians may consider having a lower threshold for ordering complete pulmonary function tests on post-9/11 veterans, particularly a bronchodilator challenge. Prospective studies in a population-based sample of deployed veterans and well-constructed, longitudinal case-control studies are necessary to evaluate the future respiratory health in this population.…”