Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations (2020) / Chapter Skim
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These operations include the 1990–1991 Persian Gulf War, a post-war stabilization period spanning 1992 through September 2001, and the campaigns undertaken in the wake of the September 11, 2001, attacks. Deployment to the Southwest Asia theater -- which for the purposes of this report is defined as Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Gulf of Aden, Gulf of Oman, Oman, Qatar, the United Arab Emirates, and the waters of the Persian Gulf, the Arabian Sea, and the Red Sea -- exposed service members to a number of airborne hazards, including oil-well fire smoke, emissions from open burn pits, dust and sand suspended in the air, and exhaust from diesel vehicles.
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This report builds on earlier literature reviews published as part of the Gulf War and Health series of National Academies reports -- in particular, Volume 4: Health Effects of Serving in the Gulf War; Volume 8: Update of Health Effects of Serving in the Gulf War; and Volume 10: Update of Health Effects of Serving in the Gulf War, 2016 -- as well as two related reports: Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan and Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. THE COMMITTEE'S APPROACH TO ANALYZING THE AVAILABLE INFORMATION The committee's literature review was a targeted examination of epidemiologic studies of respiratory health outcomes -- including excess mortality due to respiratory disease -- in military and veteran populations potentially exposed to airborne hazards in the Southwest Asia theater.
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All of these considerations were taken in account when weighing how much a study should contribute to the committee's overall evaluation of the literature base. Categories of Association A system of four categories of association was used to classify the strength of scientific evidence of respiratory health outcomes following exposure to airborne hazards in the Southwest Asia theater.
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AIRBORNE HAZARDS ENCOUNTERED IN THE SOUTHWEST ASIA THEATER Southwest Asia theater veterans were exposed to a broad range of potentially hazardous airborne agents. These include such regional environmental exposures as air pollution from dusts; local point and area sources such as traffic, waste management, and local industries; and the aeroallergens and microbial agents present in the theater.
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The committee found that there was inadequate or insufficient information to evaluate the association between service in the Southwest Asia theater and all of the remaining respiratory health outcomes it examined. While there are a variety of reasons for this that vary by the outcome under consideration, one prominent cause was the lack of good exposure characterization.
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Knowledge Gaps and Research That Could Feasibly Be Conducted to Address Them The committee identified a large number of gaps in the current information base regarding respiratory health outcomes in the population of veterans who served in the Southwest Asia theater. These can be grouped as gaps in knowledge concerning adverse respiratory health outcomes in theater veterans, gaps in knowledge concerning in-theater airborne exposures, and gaps in knowledge about the biologic and toxicologic effects of in-theater airborne exposures.
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A second knowledge gap that could be filled by appropriate research concerns the question of whether Southwest Asia theater veterans are experiencing excess mortality from respiratory diseases. The committee's review of the literature found that the most recently published mortality study of 1990–1991 Gulf War veterans, which included death due to chronic obstructive pulmonary disease and from respiratory system diseases in general, used 2004 as its cutoff date, while the last salient study of post-9/11 veterans who had been deployed to the theater was generated using data from 2011 and offered no breakout of respiratory disease mortality.
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VA is already sponsoring some work in these areas and will benefit from the information derived from it. Newly Emerging Technologies to Address Knowledge Gaps In addition to the aforementioned newly emerging technologies related to biomarker discovery and measurement and advances in remote measurement and estimation of airborne pollutants via satellites, the committee thought it appropriate to touch on some of the new technologies that might be brought to bear to gather information during active duty that would aid in the future evaluation of airborne exposures and health outcomes by VA.
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The more important question is whether deployment to the Southwest Asia theater -- with all of the hazardous airborne exposures it entailed -- may be responsible for adverse respiratory outcomes. The report's observations, conclusions, and recommendations identify not just the existing knowledge gaps but the many means that VA and the organizations that it can partner with inside and outside the government have for addressing them and providing veterans with the health information they need.
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