Log in

A Clinician’s Guide to Occupational Exposures in the Military

  • Occupational Allergies (JA Poole, Section Editor)
  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Adverse occupational and environmental exposures are common causes of respiratory disease and health consequences requiring medical care. Understanding how these various exposures affect patients and how to elicit an adequate history is critical for any clinician. Military personnel are often overlooked when discussing groups at risk for environmental exposure-associated airway disease. There are close to 20 million active duty and veterans in the USA, and nearly all clinicians will at some point care for a patient that has served in the military.

Recent Findings

Exposures related to military work include burn pits, chemicals/toxins, sandstorms, and living conditions. Burn pits and military waste are increasingly recognized as potential hazards attributed to the ongoing conflicts in the Middle East. The link between these various military exposures and acute or chronic airway diseases remains difficult. Epidemiological studies are emerging to demonstrate correlations with chronic lung disease and prolonged burn pit exposure.

Summary

This review provides an overview of potential occupational and environmental exposures that may affect current and/or former military service men and women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Department of Defense. dod.defense.gov

  2. Falvo M.J. Is deployment an exposure in military personnel? J Occup Environ Med. 2014 Nov;56(11).

  3. Dept of the Army Inspector General Special Interest Item Assessment of the Residential Communities Initiatives 2019 Mar.

  4. Rawlins FA et.al Management of asthma in the military. Fed Pract. 2015 Sep;32(10).

  5. Nish WA, Schwietz LA. Underdiagnosis of asthma in young adults presenting for USAF basic training. Ann Allergy. 1992;69(3):239–42.

    CAS  Google Scholar 

  6. South T. Supreme Court rejects appeal from veterans in burn pit lawsuit against KBR, Halliburton. MilitaryTimes. 2019. Jan.

  7. Sotolongo, A. et.al Military Burn Pits. Am J Respir Crit Care Med. 2020 Apr;201(7):13–14.

  8. Long-term health consequences of exposure to burn pits in Iraq and Afghanistan. Institute of Medicine. Oct. 2011.

  9. Banks DE, Bolduc CA, Ali S, Morris, MJ Constrictive bronchiolitis attibutable to inhalation of toxic agents: considerations for a case definition. J Occup Environ Med. 2018. Jan 60(1).

  10. Abraham JH, DeBakey SF, Reid L, Zhou, J, Baird, CP. Does deployment to Iraq and Afghanistan affect respiratory health of US military personnel? J Occup Environ Med. 2012 June 54(6).

  11. US Department of Veterans Affairs. https://www.publichealth.va.gov/exposures/burnpits/registry.asp

  12. Szema A, Mirsaidi N, Patel B. Proposed Iraq/Afghanistan War-Lung Injury (IAW-LI) clinical practice recommendations: National Academy of Sciences’ Institute of Medicine Burn Pits Workshop. Am J Mens Health. 2017;11(6):1653–63.

    Article  Google Scholar 

  13. •• Liu J, Lezama N, Gasper J, Kawata J, Morley S, Helmer D, et al. Burn pit emissions exposure and respiratory and cardiovascular conditions among airborne hazards and open burn pit registry participants. J Occup Environ Med. 2016 58(7). This study shows ongoing evidence for chronic lung disease pulled from burn pit registries.

  14. •• Sharkey JM, Abraham JH, Clark LL, Rohrbeck P, Ludwig SL, Hu Z, et al. Postdeployment respiratory health care encounters following deployment to Kabul, Afghanistan: a retrospective cohort study. Mil Med. 2016;181(3):265–71. This study provides evidence that the burn pits are associated with chronic lung disease.

  15. Coughlin SS, Szema A. Burn pits exposure and chronic respiratory illnesses among Iraq and Afghanistan Veterans. J Environ Health Sci. 2019 Feb 5 (1)

  16. Dominici F, Peng RD, Bell ML, et al. Fine particulate air pollution and hospital admission for cardiovascular and respiratory diseases. JAMA. 2006;295:1127–34.

    Article  CAS  Google Scholar 

  17. Samoli E, Peng R, Ramsay T, et al. Acute effects of ambient particulate matter on mortality in Europe and North America: results from the APHENA study. Environ Health Perspect. 2008;116:1480–6.

    Article  Google Scholar 

  18. Blasch KW, Kolivosky JE, Heller JM. Environmental air sampling near burn pit and incinerator operations at Bagram Airfield, Afghanistan. J Occup Environ Med. 2016 Aug 58(8S).

  19. Weese CB, Abraham JH. Potential health implications associated with particulate matter exposure in deployed settings in southwest Asia. Inhal Toxicol. 2009;21:291–6.

    Article  CAS  Google Scholar 

  20. Masiol, M, et al. Airborne dioxins, furans, and polycyclic aromatic hydrocarbons exposure to military personnel in Iraq. J Occup Environ Med. 2016 Aug 58(8).

  21. Conlin, AM, et al. Birth outcomes among military personnel after exposure to documented open-air burn pits before and during pregnancy. J Occup Environ Med. 2012 June 54(6).

  22. Department of Veteran Affairs. Report on data from the airborne hazards and open burn pit registry. 2015 June.

  23. Ladich ER, Lewin-Smith MR, Specht CS, et al. A histopathological study of head and neck specimens from a cohort of Persian Gulf War military veterans. Mil Med. 2002;167(10):864–7.

    Article  Google Scholar 

  24. De la Hoz RE, Shohet MR, Cohen JM. Occupational rhinosinusitis and upper airway disease: the World Trade Center experience. Curr Allergy Asthma Rep. 2010;10(2):77–83.

    Article  Google Scholar 

  25. Helfer TM, Canham-Chervak M, Canada S, Mitchener TA. Epidemiology of hearing impairment and noise-induced hearing injury among U.S. military personnel, 2003–2005. Am J Prev Med. 2010;38:S71–7.

  26. Rovig GW, Bohnker BK, Page JC. Hearing health risk in a population of aircraft carrier flight deck personnel. Mil Med. 2004;169:429–32.

    Article  Google Scholar 

  27. Humes LE, Joellenbeck LM, Durch JS. Noise and Military Service. Implications for Hearing Loss and Tinnitus. Washington, DC: National Academies Press; 2005.

  28. US Government Accountability Office. Hearing loss prevention: improvements to DOD hearing conservation programs could lead to better outcomes. Washington DC: US Government Accountability Office; 2011.

    Google Scholar 

  29. Saunders GH, Griest SE. Hearing loss in veterans and the need for hearing loss prevention programs. Noise Health. 2009;11:14–21.

    Article  Google Scholar 

  30. Geckle L, Lee R. Soldier perceptions of deployment environmental exposures. Albuquerque, NM: Paper presented at: Force Health Protection Conference; 2004. Aug

  31. Wells TS, Seelig AD, Ryan MA, et al. Hearing loss associated with US military combat deployment. Noise Health. 2015 Jan-Feb 17(74) 34–42.

  32. Saunders GH, Vachhani JJ, Galvez G, Griest SE. Formative evaluation of a multimedia self-administered computerized hearing loss prevention program. Int J Audiol. 2015;54(4):234–40.

    Article  Google Scholar 

  33. Banout J, Urban O, Musil V, et al. Agent Orange footprint still visible in rural areas of Central Vietnam. J Environ Public Health. 2014 Feb.

  34. Ngo AD, Taylor R, Roberts CL, Nguyen TV. Association between Agent Orange and birth defects: systematic review and meta-analysis. Inter Epidemiol Assoc 2006 Feb.

  35. Chang ET, Boffetta P, Adami HO, et al. A critical review of the epidemiology of Agent Orange/TCDD and prostate cancer. Eur J Epidemiol. 2014;29(10):667–723.

    Article  Google Scholar 

  36. Baumann Kreuziger LM, Tarchand G, Morrison VA, et al. The impact of Agent Orange exposure on presentation and prognosis of patients with chronic lymphocytic leukemia. Leuk Lymphoma. 2014;55(1):63–6.

    Article  CAS  Google Scholar 

  37. Landgren O, Shim YK, Michalek J, et al. Agent Orange exposure and monoclonal gammopathy of undetermined significance: a Ranch Hand Veteran cohort study. JAMA Oncol. 2015;1(8):1061–8.

    Article  Google Scholar 

  38. Sudhakar D, Clagett CL, Zacher LL. Military service and lung disease. J Occup Environ Med. 2014 Oct 56(5S).

  39. Lange JL, Schwartz DA, Doebbling BN, et al. Exposures to the Kuwait oil fires and their association with asthma and bronchitis among Gulf War Veterans. Environmental Health Perspectives. 2002 Nov 110 (11).

  40. Mumford JL, Lewtas J, Williams K, et al. Mutangenicity of organic emissions from unvented kerosene heaters in a chamber study. J Toxicol Enciron Health. 1992;36:151–9.

    Article  CAS  Google Scholar 

  41. Laslof JC, Knox M, Baldeshwieler JD. Presidential Advisory Committee on Gulf War Veteran’s Illnesses: Final Report. 1996 Dec.

  42. Franke K, Paustenbach D. Government and Navy knowledge regarding health hazards of asbestos: a state of the science evaluation (1900 to 1970). Inhal Toxicol. 2011;23:1–20.

    Article  CAS  Google Scholar 

  43. Harrington AD, Schmidt MP, Szema AM, et al. The role of Iraqi dust in inducing lung injury in United States soldiers — an interdisciplinary study. Geohealth. 2017;1(5):237–46.

    Article  Google Scholar 

  44. Meo SA, Al-Kheraiji MF, Alfaraj ZF, et al. Respiratory and general health complaints in subjects exposed to sandstorm at Riyadh Saudi Arabia. Pak J Med Sci. 2013;29(2):642–6.

    Article  Google Scholar 

  45. Krefft SD, Wolff J, Zell-Baran L, et al. Respiratory diseases in Post-911 military personnel following Southwest Asia deployment. J Occup Environ Med. 2020;62(5):337–43.

    Article  Google Scholar 

  46. Wills JR, Kang C. Chlorine gas: an evolving hazardous material threat and unconventional weapon. West J Emerg Med. 2010;11:151–6.

    Google Scholar 

  47. Sudhakar D, Clagett CL, Zacher LL. Military service and lung disease. J Occup Environ Med. 2014 Oct 56(10S).

  48. Department of the Army Inspector General Special Interest Item Assessment of the Residential Communities Initiatives. 2019 Sept.

  49. Jowers K. New association of privatized housing companies pushing back on some reforms. Military Times. 2019 Sept.

  50. Wheeler DC, Burstyn I, Vermeulen R, et al. Inside the black box: starting to uncover the underlying decision rules used in a one-by-one expert assessment of occupational exposure in case-control studies. Occup Environ Med. 2013;70:203–10.

    Article  Google Scholar 

  51. • Patel CJ, Kerr J, Thomas DC, et al. Opportunities and challenges for environmental exposure assessment in population-based studies. Cancer Epidemiol Biomarkers Prev. 2017;26:1370–80. A comprehensive overview of practices in the military to help identify and study occupational exposures.

  52. Krahl PL, Benchoff E, Go YM, et al. Advances in comprehensive exposure assessment: opportunities for the US military. J Occup Environ Med 2019, Dec 61(12).

  53. Bradburne C, Lewis JA. Personalizing environmental health: at the intersection of precision medicine and occupational health in the military. J Occup Environ Med. 2017 Nov 59(11).

Download references

Funding

JAP has received funding support through grants from the National Institute of Environmental Health Sciences (R01ES019325), National institute for Occupational Safety and Health (R01OH012045, U54OH010162), and Department of Defense (PR200793). JAP has also received research support/clinical study funding unrelated to this project from Takeda, AstraZeneca, and GlaxoSmithKline.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Joel Van De Graaff.

Ethics declarations

Conflict of Interest

The authors do not have existing conflict of interest.

Human and Animal Rights and Informed Consent

This is a review article and therefore does not have informed consent or compliance with ethical standards of human and animal rights.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Occupational Allergies

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Van De Graaff, J., Poole, J.A. A Clinician’s Guide to Occupational Exposures in the Military. Curr Allergy Asthma Rep 22, 259–264 (2022). https://doi.org/10.1007/s11882-022-01051-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11882-022-01051-0

Keywords

Navigation