Report of Autonomic Symptoms in a Clinical Sample of Veterans with Gulf War Illness.

Introduction: Previous studies suggest that autonomic dysfunction may be an underlying factor in Gulf War Illness. This study examined self-reported symptoms of autonomic dysfunction and their relationship with physical functioning among veterans with Gulf War Illness. Materials and Methods: We abstracted medical records of Gulf War Veterans clinically evaluated at the New Jersey War Related Illness and Injury Study Center between 2010 and 2016. The outcome measure was the Veteran version of the Short Form Health Survey (VR-36) physical functioning scale. Autonomic function was assessed using a composite variable constructed from the chart abstraction to mimic the Composite Autonomic Symptom Scale (COMPASS-31). Results: Seventy-six veterans were included in the final analysis. The autonomic symptom burden score was 45 (±14). Increased autonomic symptom burden, greater mental health burden (PTSD/depression), and greater body mass index were individually associated with poorer physical functioning. A general linear regression containing these variables revealed that patients with both PTSD and depression (b = -15.2, p = 0.03) or either PTSD or depression (b = -22.7, p < 0.01) had lower physical functioning than those without; the other variables became not significant (body mass index: p = 0.07; autonomic function: p = 0.89). Conclusion: The average autonomic function score indicated significant burden in Gulf War Veterans, consistent with published research. We did not detect an independent association between autonomic symptom burden and physical functioning, likely due to the non-specific nature of the measure used to capture autonomic symptoms or the stronger association between mental health conditions and physical functioning. Future work utilizing valid and standardized instruments to clinically evaluate autonomic function is warranted.

Isolated diffusing capacity reduction is a common clinical presentation in deployed Iraq and Afghanistan veterans with deployment-related environmental exposures.

Following deployment to Iraq and Afghanistan ("post-9/11"), a spectrum of respiratory conditions has been reported; however, there are few published reports of objective physiologic data or later experience of symptoms and function. To better understand the post-deployment clinical presentation, we conducted a retrospective review of pulmonary function testing in 143 veterans referred to our tertiary care clinic for post-deployment health concerns. More than 75% of our sample had normal lung volumes and spirometry on pulmonary function testing; however, an isolated reduction in lung diffusing capacity (DLCO) was observed in 30% of our sample of post-9/11 veterans. An isolated reduction in DLCO is a rare pattern in primary-care seeking dyspneic patients, but is commonly associated with underlying pulmonary disease. Post-9/11 veterans with respiratory complaints and an isolated reduction in DLCO should undergo further evaluation.

Bronchodilator Responsiveness and Airflow Limitation Are Associated With Deployment Length in Iraq and Afghanistan Veterans.

OBJECTIVE: The aim of this study was to determine the relationship between deployment length and indices of airflow obstruction in Iraq and Afghanistan veterans with airborne hazards exposure. METHODS: One hundred twenty-four post-9/11 veterans completed pulmonary function testing and questionnaires. We examined the association of airflow limitation [forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC)] and bronchodilator responsiveness (ΔFEV1 and ΔFVC) with deployment length, adjusting for smoking. RESULTS: Longer deployment length was associated with lower FEV1/FVC [ß = -0.19; 95% confidence interval (95% CI), -0.39 to 0.01], greater ΔFEV1 (ß = 0.27; 95% CI, 0.09 to 0.45) and ΔFVC (ß = 0.19; 95% CI, 0.05 to 0.33). In our model adjusted for smoking history, longer deployment length remained associated with greater ΔFEV1 and ΔFVC (P < 0.01), but not with FEV1/FVC (P = 0.059). CONCLUSION: In our sample of post-9/11 veterans, longer deployment lengths were associated with significant bronchodilator responsiveness and a trend toward airflow limitation independent of tobacco use.