Airborne hazards exposure and respiratory health of Iraq and Afghanistan veterans

Epidemiol Rev. 2015;37:116-30. doi: 10.1093/epirev/mxu009. Epub 2015 Jan 14.


More than 2.6 million military personnel have been deployed to recent conflicts in Iraq and Afghanistan and were likely exposed to a variety of airborne hazards during deployment. Despite several epidemiologic reports of increased respiratory symptoms, whether or not these respiratory illnesses lead to reductions in lung function and/or specific pulmonary disease is unclear. We reviewed data published from 2001 to 2014 pertaining to respiratory health in military personnel deployed to Iraq and Afghanistan and found 19 unique studies. Study designs were primarily retrospective and observational in nature with patient symptom reporting and medical encounter data as primary outcome measures. Two case series reported on rare respiratory diseases, and one performed a standardized evaluation of new-onset respiratory symptoms. Respiratory outcomes in relation to proximity to a specific air pollution source (i.e., smoke from burning trash and sulfur mine fire) were described in 2 separate studies. Only 2 longitudinal investigations were identified comparing pre- and postdeployment measurement of exercise capacity. In summary, published data based on case reports and retrospective cohort studies suggest a higher prevalence of respiratory symptoms and respiratory illness consistent with airway obstruction. However, the association between chronic lung disease and airborne hazards exposure requires further longitudinal research studies with objective pulmonary assessments.

Keywords: Operation Enduring Freedom; Operation Iraqi Freedom; air pollution; airborne particulate matter; environmental exposures; occupational exposure; pulmonary diseases; veterans’ health.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

MeSH terms

  • Afghan Campaign 2001-*
  • Air Pollutants, Occupational / adverse effects
  • Air Pollution / adverse effects*
  • Humans
  • Inhalation Exposure / adverse effects*
  • Iraq War, 2003-2011*
  • Occupational Exposure / adverse effects*
  • Respiratory Tract Diseases / etiology*
  • United States
  • Veterans Health*


  • Air Pollutants, Occupational