Interstitial Lung Disease Deserves Attention Among Veterans

By Divya Patel, DO, MBA and Director of Clinical Development and Medical Affairs for IPF/ILD, Boehringer Ingelheim

Upon their return from service and in the decades that follow, veterans can face a myriad of health issues that have a long-term effect on their well-being. The prevalence of health issues like post-traumatic stress disorder, substance use disorder and traumatic brain injury have been well-documented among a veteran population. The mental and emotional toll of these issues is profound, so much so that it can be easy to overlook physical symptoms of other service-related disease risks. But when we consider the health risks facing veterans today, we cannot overlook the long-term effects of toxic substance exposure on lung health.

As a result of their exposure to toxic substances like smoke and fumes from open burn pits, sand, dust, and other particulate matter or mechanical fumes from fuel or aircraft exhaust, veterans of the Gulf Wars or post-9/11 eras are at an increased risk for developing chronic lung diseases, including interstitial lung disease (ILD). While ILD is considered rare, it refers to a broad category that encompasses more than 200 lung disorders marked by scarring and inflammation, commonly referred to as pulmonary fibrosis. It can affect anyone regardless of age, race, background and health status but exposure to toxic pollutants can greatly impact a person’s ILD risk.

Research indicates that the number of veterans exposed to these pollutants is significant. Based on the latest data available from July 2023, 1.9 million veterans screened for exposure to airborne hazards and pollutants had at least one exposure to these pollutants during their time in military service.

The symptoms of ILD are often similar to those of other lung diseases, and commonly include shortness of breath, a persistent dry cough and fatigue. Because these symptoms are indistinct, many people who have an ILD delay seeking care because they attribute their symptoms to factors like declining fitness level, aging, a history of smoking or other co-morbidities.

As we have likely all done at one time or another with personal health issues, it can be easy to brush off symptoms. But most forms of ILD are progressive, meaning scarring and inflammation can worsen over time and ultimately progress to a point where symptoms are impossible to ignore. People living with progressive forms of ILD often cite a feeling of breathlessness, so much so that it can be difficult to complete everyday activities like climbing the stairs or taking a walk. Not only can this make daily life more difficult, but these worsening symptoms can also be a sign of declining lung function.

The progressive nature of ILD underscores why it is imperative for people who are at risk for this disease—including veterans—to not only know and understand their unique risk factors, but to treat the symptoms of ILD with the same urgency and attention that is paid to other health issues.

Recent findings support the need for greater awareness of ILD among the veteran community. From 2010 to 2019, the incidence rate of ILD in veterans more than doubled. While this increase in diagnoses is staggering, it has also spurred action. In response to this increase in chronic lung disease diagnoses among veterans—many of whom have spoken out about their symptoms and the risk of exposure—President Biden recently signed a piece of legislation that makes it easier for veterans to understand their risk for ILD and be connected with a care provider.

The Promise to Address Comprehensive Toxics (PACT) Act is a piece of federal legislation that expands Veterans Affairs (VA) healthcare benefits to cover more than 20 presumptive conditions for toxic exposures experienced during military service, including pulmonary fibrosis and ILD. Thanks to the PACT Act, veterans may have the opportunity to receive an initial chronic lung disease screening, plus a follow-up screening at least once every five years. Veterans who meet the eligibility requirements but who are not currently enrolled in VA healthcare may also have an opportunity to receive the screening upon enrollment. More information and resources are available on the VA website.

As we continue to examine how we can best serve our veterans from a healthcare perspective, it is imperative that we continue to commit to understanding the long-term respiratory health risks of military service and working with the VA and other practitioners to identify and mitigate these risks.

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