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Lung Capacity and Compliance Are Associated with Blast Exposure in Veterans of Iraq and Afghanistan
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A6080 - Lung Capacity and Compliance Are Associated with Blast Exposure in Veterans of Iraq and Afghanistan
Author Block: M. J. Falvo, A. M. Sotolongo, N. Jani, J. Klein, O. Osinubi, D. Ndirangu, N. Eager, D. Helmer; War Related Illness and Injury Study Center, VA NJ Health Care System, East Orange, NJ, United States.
Rationale: Blast exposure during military deployment has recently been found to be associated with symptoms of dyspnea and exercise intolerance among participants in a national registry. However, objective pulmonary function data supporting this relationship is presently lacking. Therefore, the purpose of this study is to compare pulmonary function between Veterans with (Blast+) and without (Blast-) exposure.
Methods: 129 deployed Iraq and Afghanistan Veterans who were referred to our national specialty care clinic were included in this study. All Veterans participated in a multi-day comprehensive clinical evaluation that included complete pulmonary function testing via body plethysmography, spirometry and diffusing capacity. Blast exposure was determined via self-report (yes/no). Current and former smokers were excluded from the analysis.
Results: 58.1% of our sample (n = 75) reported blast exposure during their deployment. Both groups were lifetime never-smokers and had similar body mass indices (30.9±5.9 vs. 30.3±5.1 kg/m2). Blast+ were younger (Blast+ vs. Blast-; 40.9±8.3 vs. 45.7±9.5 years, p = 0.002), had longer cumulative deployment lengths (11.5±6.4 vs. 8.5±5.7 months, p = 0.007), and were more likely to screen positive for post-traumatic stress disorder (PTSD: 36.5% vs. 20.4%, p = 0.049) and be male (88.0% vs. 74.1%, p = 0.041) than Blast-. Total lung capacity (TLC: 89.5±13.3% vs. 95.8±13.4%, p = 0.009, d = 0.47) and functional residual capacity (FRC: 85.5±21.1% vs. 94.7±25.4%, p = 0.026, d = 0.39) were significantly reduced in Blast+ Veterans; Blast+ Veterans were also more likely to have a restrictive ventilatory defect (17.3% vs. 0.0%, p = 0.001). All other pulmonary function indices were similar between groups.
Conclusions: In our sample of treatment seeking deployed Iraq and Afghanistan Veterans, those with blast exposure were more likely to have a restrictive pattern on pulmonary function testing. Further, Veterans with blast exposure have significantly reduced TLC and FRC which is consistent with a phenotype of reduced lung capacity and compliance. These objective data corroborate our report of an association between blast exposure and symptoms of dyspnea and exercise intolerance. Future work is necessary to confirm this as a blast-induced phenotype and determine the mechanism(s) of injury.
Author Block: M. J. Falvo, A. M. Sotolongo, N. Jani, J. Klein, O. Osinubi, D. Ndirangu, N. Eager, D. Helmer; War Related Illness and Injury Study Center, VA NJ Health Care System, East Orange, NJ, United States.
Rationale: Blast exposure during military deployment has recently been found to be associated with symptoms of dyspnea and exercise intolerance among participants in a national registry. However, objective pulmonary function data supporting this relationship is presently lacking. Therefore, the purpose of this study is to compare pulmonary function between Veterans with (Blast+) and without (Blast-) exposure.
Methods: 129 deployed Iraq and Afghanistan Veterans who were referred to our national specialty care clinic were included in this study. All Veterans participated in a multi-day comprehensive clinical evaluation that included complete pulmonary function testing via body plethysmography, spirometry and diffusing capacity. Blast exposure was determined via self-report (yes/no). Current and former smokers were excluded from the analysis.
Results: 58.1% of our sample (n = 75) reported blast exposure during their deployment. Both groups were lifetime never-smokers and had similar body mass indices (30.9±5.9 vs. 30.3±5.1 kg/m2). Blast+ were younger (Blast+ vs. Blast-; 40.9±8.3 vs. 45.7±9.5 years, p = 0.002), had longer cumulative deployment lengths (11.5±6.4 vs. 8.5±5.7 months, p = 0.007), and were more likely to screen positive for post-traumatic stress disorder (PTSD: 36.5% vs. 20.4%, p = 0.049) and be male (88.0% vs. 74.1%, p = 0.041) than Blast-. Total lung capacity (TLC: 89.5±13.3% vs. 95.8±13.4%, p = 0.009, d = 0.47) and functional residual capacity (FRC: 85.5±21.1% vs. 94.7±25.4%, p = 0.026, d = 0.39) were significantly reduced in Blast+ Veterans; Blast+ Veterans were also more likely to have a restrictive ventilatory defect (17.3% vs. 0.0%, p = 0.001). All other pulmonary function indices were similar between groups.
Conclusions: In our sample of treatment seeking deployed Iraq and Afghanistan Veterans, those with blast exposure were more likely to have a restrictive pattern on pulmonary function testing. Further, Veterans with blast exposure have significantly reduced TLC and FRC which is consistent with a phenotype of reduced lung capacity and compliance. These objective data corroborate our report of an association between blast exposure and symptoms of dyspnea and exercise intolerance. Future work is necessary to confirm this as a blast-induced phenotype and determine the mechanism(s) of injury.
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