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Post-9/11 Veterans With Blast Exposure Face Dyspnea
TOPLINE:
Among 401 post-9/11 veterans with retained embedded fragments, those with blast exposure (n = 361) were more likely to report dyspnea compared with unexposed veterans, though both groups reported respiratory symptoms (ie, cough, phlegm, wheeze). Veterans with blast exposure demonstrated higher forced vital capacity (FVC), total lung capacity (TLC), and diffusing capacity of carbon monoxide (DLCO) values, suggesting better lung function, while those with traumatic brain injury (TBI) showed lower lung volumes.
METHODOLOGY:
- A total of 402 veterans from the US Department of Veterans Affairs (VA) Toxic Embedded Fragment (TEF) Registry across 6 VA facilities were recruited from April 2018 through March 2021; 361 reported blast exposure, 41 did not.
- Participants completed questionnaires assessing blast exposure using the Brief Traumatic Brain Injury Screening (BTBIS), history of TBI, and respiratory symptoms and diagnoses based on the American Thoracic Society and Division of Lung Disease questionnaire.
- A total of 369 veterans underwent prebronchodilator pulmonary function testing (PFT) including spirometry, lung volumes, and diffusion capacity, as well as impulse oscillometry (IOS) testing; 33 participants recruited after March 2020 were excluded from physiologic testing due to COVID-19 pandemic restrictions.
- Primary outcomes included respiratory symptoms (cough, wheeze, dyspnea) and diagnoses (chronic obstructive pulmonary disease, asthma), while secondary outcomes included PFT and IOS measures such as forced expiratory volume in 1 second (FEV1), FVC, TLC, functional residual capacity (FRC), residual volume (RV), DLCO, and resistance and reactance parameters.
TAKEAWAY:
- Veterans with blast exposure were significantly more likely to report shortness of breath when hurrying on level ground or walking up a slight hill compared with those without blast exposure (adjusted odds ratio [aOR], 2.35; 95% CI, 1.04-5.33; P = .040).
- Blast-exposed veterans demonstrated significantly higher mean measured values for FVC (4.81 L vs 4.62 L; P = .010), TLC (6.46 L vs 6.12 L; P = .024), and DLCO (28.87 ml/min/mmHg vs 27.65 ml/min/mmHg; P = .041) compared with unexposed veterans.
- Among blast-exposed veterans, those with self-reported TBI diagnosis had significantly lower TLC (P = .04), FRC (P = .003), RV (P = .003), and RV/TLC ratio (P = .014) compared with veterans without TBI.
- No significant differences were noted between blast-exposed and unexposed groups in prevalence of cough, phlegm, wheeze, respiratory diagnoses, or IOS testing outcomes.
IN PRACTICE:
"When assessed using affirmative responses to the BTBIS to signify blast-exposure, we found few differences in blast exposed compared to unexposed veterans regarding respiratory symptoms, except for increased mild dyspnea among those with blast exposure. However, this cohort of young veterans overall expressed a high prevalence of respiratory symptoms without a similarly high prevalence of respiratory diagnoses," wrote the authors of the study.
SOURCE:
The study was led by Danielle R. Glick, Department of Veterans Affairs Medical Center, Baltimore, and Stella E. Hines, University of Maryland School of Medicine, Baltimore. It was published online May 12 in Frontiers in Public Health.
LIMITATIONS:
The study had a small sample of participants not exposed to blasts (41 vs 361 exposed), which may have limited the ability to detect small differences between groups, though the sample size provided 80% power to detect medium effect sizes. Blast exposure was assessed using self-reported responses from the BTBIS tool, which may have created exposure misclassification and obscured dose-response relationships beyond the severity analysis surrogates. The study relied on self-reported data without verification through medical records or imaging, which may have introduced recall bias. Participants were recruited exclusively from the TEF registry of veterans who sought VA care, which may not represent the broader post-9/11 veteran population.
DISCLOSURES:
This study received financial support under Department of Defense grant number W81XWH-16-2-0058 from the Congressionally Directed Medical Research Program. The study received approval from the VA Central Institutional Review Board (protocol #17-13), the US Army Medical Research and Development Command Human Research Protection Office (protocol A-19735), and local VA Research and Development Committees at the Baltimore, Gainesville, Nashville, Oklahoma City, San Antonio, and Phoenix VA Medical Centers along with their affiliated institutional review boards. No relevant conflicts of interest were disclosed by the authors. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
TOPLINE:
Among 401 post-9/11 veterans with retained embedded fragments, those with blast exposure (n = 361) were more likely to report dyspnea compared with unexposed veterans, though both groups reported respiratory symptoms (ie, cough, phlegm, wheeze). Veterans with blast exposure demonstrated higher forced vital capacity (FVC), total lung capacity (TLC), and diffusing capacity of carbon monoxide (DLCO) values, suggesting better lung function, while those with traumatic brain injury (TBI) showed lower lung volumes.
METHODOLOGY:
- A total of 402 veterans from the US Department of Veterans Affairs (VA) Toxic Embedded Fragment (TEF) Registry across 6 VA facilities were recruited from April 2018 through March 2021; 361 reported blast exposure, 41 did not.
- Participants completed questionnaires assessing blast exposure using the Brief Traumatic Brain Injury Screening (BTBIS), history of TBI, and respiratory symptoms and diagnoses based on the American Thoracic Society and Division of Lung Disease questionnaire.
- A total of 369 veterans underwent prebronchodilator pulmonary function testing (PFT) including spirometry, lung volumes, and diffusion capacity, as well as impulse oscillometry (IOS) testing; 33 participants recruited after March 2020 were excluded from physiologic testing due to COVID-19 pandemic restrictions.
- Primary outcomes included respiratory symptoms (cough, wheeze, dyspnea) and diagnoses (chronic obstructive pulmonary disease, asthma), while secondary outcomes included PFT and IOS measures such as forced expiratory volume in 1 second (FEV1), FVC, TLC, functional residual capacity (FRC), residual volume (RV), DLCO, and resistance and reactance parameters.
TAKEAWAY:
- Veterans with blast exposure were significantly more likely to report shortness of breath when hurrying on level ground or walking up a slight hill compared with those without blast exposure (adjusted odds ratio [aOR], 2.35; 95% CI, 1.04-5.33; P = .040).
- Blast-exposed veterans demonstrated significantly higher mean measured values for FVC (4.81 L vs 4.62 L; P = .010), TLC (6.46 L vs 6.12 L; P = .024), and DLCO (28.87 ml/min/mmHg vs 27.65 ml/min/mmHg; P = .041) compared with unexposed veterans.
- Among blast-exposed veterans, those with self-reported TBI diagnosis had significantly lower TLC (P = .04), FRC (P = .003), RV (P = .003), and RV/TLC ratio (P = .014) compared with veterans without TBI.
- No significant differences were noted between blast-exposed and unexposed groups in prevalence of cough, phlegm, wheeze, respiratory diagnoses, or IOS testing outcomes.
IN PRACTICE:
"When assessed using affirmative responses to the BTBIS to signify blast-exposure, we found few differences in blast exposed compared to unexposed veterans regarding respiratory symptoms, except for increased mild dyspnea among those with blast exposure. However, this cohort of young veterans overall expressed a high prevalence of respiratory symptoms without a similarly high prevalence of respiratory diagnoses," wrote the authors of the study.
SOURCE:
The study was led by Danielle R. Glick, Department of Veterans Affairs Medical Center, Baltimore, and Stella E. Hines, University of Maryland School of Medicine, Baltimore. It was published online May 12 in Frontiers in Public Health.
LIMITATIONS:
The study had a small sample of participants not exposed to blasts (41 vs 361 exposed), which may have limited the ability to detect small differences between groups, though the sample size provided 80% power to detect medium effect sizes. Blast exposure was assessed using self-reported responses from the BTBIS tool, which may have created exposure misclassification and obscured dose-response relationships beyond the severity analysis surrogates. The study relied on self-reported data without verification through medical records or imaging, which may have introduced recall bias. Participants were recruited exclusively from the TEF registry of veterans who sought VA care, which may not represent the broader post-9/11 veteran population.
DISCLOSURES:
This study received financial support under Department of Defense grant number W81XWH-16-2-0058 from the Congressionally Directed Medical Research Program. The study received approval from the VA Central Institutional Review Board (protocol #17-13), the US Army Medical Research and Development Command Human Research Protection Office (protocol A-19735), and local VA Research and Development Committees at the Baltimore, Gainesville, Nashville, Oklahoma City, San Antonio, and Phoenix VA Medical Centers along with their affiliated institutional review boards. No relevant conflicts of interest were disclosed by the authors. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
TOPLINE:
Among 401 post-9/11 veterans with retained embedded fragments, those with blast exposure (n = 361) were more likely to report dyspnea compared with unexposed veterans, though both groups reported respiratory symptoms (ie, cough, phlegm, wheeze). Veterans with blast exposure demonstrated higher forced vital capacity (FVC), total lung capacity (TLC), and diffusing capacity of carbon monoxide (DLCO) values, suggesting better lung function, while those with traumatic brain injury (TBI) showed lower lung volumes.
METHODOLOGY:
- A total of 402 veterans from the US Department of Veterans Affairs (VA) Toxic Embedded Fragment (TEF) Registry across 6 VA facilities were recruited from April 2018 through March 2021; 361 reported blast exposure, 41 did not.
- Participants completed questionnaires assessing blast exposure using the Brief Traumatic Brain Injury Screening (BTBIS), history of TBI, and respiratory symptoms and diagnoses based on the American Thoracic Society and Division of Lung Disease questionnaire.
- A total of 369 veterans underwent prebronchodilator pulmonary function testing (PFT) including spirometry, lung volumes, and diffusion capacity, as well as impulse oscillometry (IOS) testing; 33 participants recruited after March 2020 were excluded from physiologic testing due to COVID-19 pandemic restrictions.
- Primary outcomes included respiratory symptoms (cough, wheeze, dyspnea) and diagnoses (chronic obstructive pulmonary disease, asthma), while secondary outcomes included PFT and IOS measures such as forced expiratory volume in 1 second (FEV1), FVC, TLC, functional residual capacity (FRC), residual volume (RV), DLCO, and resistance and reactance parameters.
TAKEAWAY:
- Veterans with blast exposure were significantly more likely to report shortness of breath when hurrying on level ground or walking up a slight hill compared with those without blast exposure (adjusted odds ratio [aOR], 2.35; 95% CI, 1.04-5.33; P = .040).
- Blast-exposed veterans demonstrated significantly higher mean measured values for FVC (4.81 L vs 4.62 L; P = .010), TLC (6.46 L vs 6.12 L; P = .024), and DLCO (28.87 ml/min/mmHg vs 27.65 ml/min/mmHg; P = .041) compared with unexposed veterans.
- Among blast-exposed veterans, those with self-reported TBI diagnosis had significantly lower TLC (P = .04), FRC (P = .003), RV (P = .003), and RV/TLC ratio (P = .014) compared with veterans without TBI.
- No significant differences were noted between blast-exposed and unexposed groups in prevalence of cough, phlegm, wheeze, respiratory diagnoses, or IOS testing outcomes.
IN PRACTICE:
"When assessed using affirmative responses to the BTBIS to signify blast-exposure, we found few differences in blast exposed compared to unexposed veterans regarding respiratory symptoms, except for increased mild dyspnea among those with blast exposure. However, this cohort of young veterans overall expressed a high prevalence of respiratory symptoms without a similarly high prevalence of respiratory diagnoses," wrote the authors of the study.
SOURCE:
The study was led by Danielle R. Glick, Department of Veterans Affairs Medical Center, Baltimore, and Stella E. Hines, University of Maryland School of Medicine, Baltimore. It was published online May 12 in Frontiers in Public Health.
LIMITATIONS:
The study had a small sample of participants not exposed to blasts (41 vs 361 exposed), which may have limited the ability to detect small differences between groups, though the sample size provided 80% power to detect medium effect sizes. Blast exposure was assessed using self-reported responses from the BTBIS tool, which may have created exposure misclassification and obscured dose-response relationships beyond the severity analysis surrogates. The study relied on self-reported data without verification through medical records or imaging, which may have introduced recall bias. Participants were recruited exclusively from the TEF registry of veterans who sought VA care, which may not represent the broader post-9/11 veteran population.
DISCLOSURES:
This study received financial support under Department of Defense grant number W81XWH-16-2-0058 from the Congressionally Directed Medical Research Program. The study received approval from the VA Central Institutional Review Board (protocol #17-13), the US Army Medical Research and Development Command Human Research Protection Office (protocol A-19735), and local VA Research and Development Committees at the Baltimore, Gainesville, Nashville, Oklahoma City, San Antonio, and Phoenix VA Medical Centers along with their affiliated institutional review boards. No relevant conflicts of interest were disclosed by the authors. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Post-9/11 Veterans With Blast Exposure Face Dyspnea
Post-9/11 Veterans With Blast Exposure Face Dyspnea