Veterans’ Health: The Link Between Blast Exposure and Respiratory Symptoms

Mature Asian doctor talks with armed forces veteran during evaluation. The veteran is sitting in a wheelchair. Only his back is seen in the photo. The doctor is wearing a lab coat and is holding the patient’s medical file.
Do veterans who experience exposure to blasts have a higher prevalence of pulmonary symptoms than those not subject to blast exposure?

Self-reported blast exposure by veterans can significantly predict the development of respiratory symptoms, which may occur years after the traumatic injury and incident. These were among study findings published in the journal Respiratory Medicine.

Recognizing that service members who sustain blast exposure frequently experience injuries from embedded metal fragments, the researchers sought to evaluate individuals from the Department of Veterans Affairs (VA) Toxic Embedded Fragment (TEF) Registry for links between respiratory symptoms and diagnoses with blast exposure. They hypothesized that veterans who experience exposures to blasts would have a higher prevalence of pulmonary symptoms and self-reported diagnoses than those who did not sustained blast exposures.

Questionnaires were sent to 9000 eligible veterans enrolled in the VA before January 2020. Eligibility meant that veterans were at risk for having an embedded fragment from an injury sustained while serving in Southwest Asia and Afghanistan military conflicts post 9/11/2001. The questionnaire, which could be completed on paper or online, evaluated chronic respiratory symptoms, exposures, and diagnoses. Blast exposure was evaluated via use of the Brief Traumatic Brain Injury Screen, which also assessed the presence of other symptoms such as blast-induced loss of consciousness.

A total of 2147 veterans who completed the survey were included in the study analysis.

This sample was predominantly male, White, and had served in the US Army.  Overall, 91% of the respondents reported blast exposure. These veterans reporting blast exposure differed from those not reporting such exposure with respect to age, marital status, military branch, pack-years of smoking, time since injury, and occupational fumes or gas exposure.

Many of the participants reported pulmonary symptoms and diagnoses. Veterans reporting blast exposure were more likely to experience respiratory symptoms, including cough, dyspnea, and wheezing, as well as an aggregate assessment of reporting any severe respiratory symptoms (odds ratio [OR], 2.2; 95% CI, 1.6-3.0), compared with those not exposed to blasts.

Veterans reporting blast exposure were also more likely than those not exposed to report any respiratory diagnoses (OR, 1.5; 95% CI, 1.0-2.1). Specifically, those reporting blast exposure were more likely to report wheeze (OR, 2.4), cough (OR, 1.8), and dyspnea (OR, 1.8), even after adjustment for covariates such as smoking, as well as occupational exposures to dust, fumes, and gas. Those veterans who reported a higher severity of blast impact, including traumatic brain injury or loss of consciousness, were more likely to experience wheeze, cough, or dyspnea.

Additionally, veterans who reported a higher severity of blast impact per multiple measures were more likely to report having chronic obstructive pulmonary disease (COPD). Participants with a physician diagnosis of traumatic brain injury were significantly more likely to report having asthma or COPD (OR, 1.5 and P =.03 for both).

The study was limited by recall bias, stemming from the fact that data were self-reported, without physician/medical record confirmation of diagnoses. There may also be some degree of selection bias, given that study participants were recruited from TEF Registry veterans who have sought VA care.

The researchers concluded that “Future studies should further investigate mechanistic hypotheses for chronic lung injury from pulmonary barotrauma. Further, respiratory system evaluation may warrant inclusion as a standard part of barotrauma health assessment.”

Disclosure: One study author has declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures.


Hines SE, Gaitens JM, Brown CH, et al. Self-reported respiratory outcomes associated with blast exposure in post 9/11 veterans. Respir Med. Published online August 22, 2022. doi:10.1016/j.rmed.2022.106963