The impact of combat deployment on asthma diagnosis and severity

Abstract

Objectives: Environmental exposures during military deployments to Iraq and Afghanistan may lead to higher rates of respiratory complaints and diagnoses. This study investigates whether there is a relationship between rates of asthma diagnosis and severity associated with military deployment. Methods: Retrospective review of active duty Army personnel underwent fitness for duty evaluation (Medical Evaluation Board) for asthma. The electronic medical record was reviewed for onset of diagnosis (pre- or post-deployment), disease severity, screening spirometry, bronchodilator response and bronchoprovocation testing. We compared patients with and without a history of combat deployment to Operations Iraqi Freedom/Enduring Freedom. Results: Four hundred consecutive Army personnel with a clinical diagnosis of asthma were evaluated. Equal numbers of patients had deployed (48.5%) versus never deployed (51.5%). Of those who deployed, 98 (24.5%) were diagnosed post-deployment. The diagnosis of asthma was objectively confirmed in 74.8% of patients by obstructive screening spirometry, bronchodilator response, and/or methacholine challenge testing. There were no significant differences in spirometry between deployers and non-deployers or based on pre- and post-deployment diagnosis. Similarly, asthma severity classification did not differ between deployed and non-deployed service members, or by pre- and post-deployment diagnosis status. Conclusions: Among active duty military personnel with career limiting asthma, there is no significant relationship between rates of diagnosis or severity based on history of deployment to Southwest Asia.

• Asthma
• deployment
• military personnel
• pulmonary function testing

Acknowledgements

Dr. Michael Morris is the guarantor for the accuracy and integrity of the data and results presented in this manuscript. Dr. Michael Morris participated in study design, data interpretation, and manuscript writing and editing. Dr. Sally DelVecchio participated in study design, performed all data collection, data interpretation, and the majority of manuscript writing and editing. Dr. Jacob Collen participated in data interpretation, manuscript writing and editing. Dr. Lisa Zacher participated in study design and data interpretation. Dr. Roy Haas, PhD, assisted in performing statistical analysis.

Declaration of interest

The opinions in this essay do not constitute endorsement by San Antonio Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, Department of Defense, or the U.S. Government of the information contained therein. Dr. Morris is a paid speaker for Spiriva® by Boehringer-Ingelheim. The other authors have no financial interests to disclose. None of the authors have any relevant conflicts of interest to disclose. This study was not supported by any funding or financial sponsorship. The authors alone are responsible for the content and writing of the paper.