Abstract Rationale Based on clinical case series, dyspnea among Veterans returning from land-based deployments to Afghanistan and Southwest Asia has emerged as a cardinal symptom, raising concern about pulmonary disease. The prevalence, severity, and spirometry assessment associated with this dyspnea have not been well described. Methods We used survey data from the Veterans Health Care (VHA) Cooperative Studies Program Service and Health Among Deployed Veterans (SHADE). Participants were randomly recruited using the Defense Manpower Data Center (DMDC) deployment roster independent of symptoms or VHA health care. Post-9/11 Veterans with land-based deployments in Afghanistan and Southwest Asia, living within 25 miles of 6 major VHA care centers completed interviewer-administered surveys that included items based on the modified Medical Research Council (mMRC) dyspnea scores and completed spirometry. We estimated associations between dyspnea grade and forced expiratory volume in one second (FEV1) or forced vital capacity (FVC) using generalized estimating equations (GEE) to account for correlation within study site, and adjusting for age, race, sex, height, BMI, smoking status, and pack years. Results Among 3393 study participants (mean age 42.8 years (SD 9.6), 87.5%male), 56.2% reported never smoking, 32.9% formerly smoked, and 10.9% currentlysmoked cigarettes. Among the 1338 who either formerly or currently smoked and not missingpackyears, median (IQR) packyears was 3.75 (1.00, 9.58) years. 89 (2.6%) reported breathlessness other than with strenuous exercise but did not meet criteria for Grade 1 dyspnea. 91 (2.7%) reported shortness of breath when hurrying on level ground or walking up a slight hill (Grade 1), 51 (1.5%) reported walking slower than people of the same age on level ground due to breathlessness, or stopping to catch breath when walking at their own pace (Grade 2), and 51 (1.5%) reported stopping for breath after walking about 100 yards (or after a few minutes) on level ground (Grade 3). In post-bronchodilator spirometry, 7% of FVC and 6% of FEV1 values were below the lower limit of normal (Global Lung Initiative 2012). In the adjusted generalized estimating equation (n = 3241) a higher dyspnea grade was associated with a reduction in FEV1 and FVC (Table 1). Conclusions In this younger Veteran population with few current smokers, althoughthe prevalence Grade 2 and 3 dyspnea was low, such symptoms were associatedwith decrements in lung function. This abstract is funded by: This work was supported by the VA Cooperative Studies Program #595: Pulmonary Health and Deployment to Southwest Asia and Afghanistan (also known as SHADE Service and Health Among Deployed Veterans) from the VA Office of Research and Development, Cooperative Studies Program and toxic exposure funds through the VA Military Exposures Research Program. The contents do not represent the views of the US Department of Veterans Affairs or the US Government
Fair et al. (Fri,) studied this question.