Paper investigates air quality during Gulf War

WASHINGTON, July 27, 2000 (GulfLINK) - The Office of the Special Assistant for Gulf War Illnesses released today an environmental exposure report that addresses the effects of exposure to poor air quality during the Gulf War and the effect it may have had on the health of Gulf War veterans. Investigators assessed the risk of adverse long-term health problems from exposure to be minimal.

The region's air quality was a primary concern due to the high levels of dust and sand particles present in this region of the world. In addition to blowing sand from the desert environment, soot and the by-products of combusted crude oil contributed to the poor air quality. These particles are collectively referred to as particulate matter.

Particulate matter is a generic term applied to a broad class of chemically, physically and biologically diverse substances spanning a range of particle sizes. The chemical composition of the samples indicate that roughly 75 percent of the airborne particulate matter consisted of clays, primarily calcium and silica originating from the sand indigenous to the region. Another 10 to 23 percent was soot that originated from a variety of sources, including oil well fires and other industrial sources, and less than 10 percent came from miscellaneous sources.

The environmental exposure report is intended to present what is currently known regarding U.S. servicemember exposures to particulate matter while serving in the Gulf War, and to summarize the results of the medical literature review and qualitative risk assessment presented in the May 2000 report "Particulate Exposure During the Persian Gulf War" written by Richard Thomas, Torgny Vigerstad, John Meagher and Chad McMullin. This report, commissioned by the special assistant's office, examines respirable and soot concentrations - the principal components of concern in particulate matter - from monitoring data and provides an estimate of troop exposure. The overall objective of the Thomas report is to determine the likelihood of the onset of chronic or long-term effects rising from particulate matter exposure.

Particulate matter levels were often twice the recommended levels for safeguarding health. While pre-war monitoring data indicated that these levels are among the highest in the world, they are considered "normal" for the Kuwaiti region and result primarily from natural and man-made sources.

From May to December 1991, numerous efforts were undertaken to assess the air quality in Kuwait and Saudi Arabia. Air quality sampling and monitoring data were collected by several agencies and various countries. Collectively, the data indicated that, with the exception of particulate matter, pollutant levels were surprisingly low.

"Data of this nature is critical in developing a causal relationship and in determining whether there was a potential for long-term health effects in Gulf War veterans," said William Shaughnessy, the lead investigator on the report.

The report also found that there was a significant mass of particles in the respirable size range, that is, those less than 10 microns in diameter. Particles of this size have the potential to reach deep into the lungs. When found at high concentrations in the general environment, these particles have been associated with changes in lung function, damage to lung tissue, and the impaired ability to eject foreign matter via exhalation.

"It is extremely important to keep in mind that the critical dose one receives - that is, the amount of a contaminant necessary to induce some adverse health effect - is as much a function of the length of time an individual was exposed as is the actual concentration to which the person was exposed," said Bernard Rostker, the special assistant for Gulf War illnesses.

"In this case, Gulf War veterans were exposed to relatively high levels of particulate matter, that is, they frequently exceeded U.S. ambient air quality standards while serving in the Gulf area. However, the amount of time they were exposed to these levels was short when compared to occupational exposures which occur over a working lifetime," added Rostker.

According to the report, high particulate matter levels, from a health effects perspective, have been linked with allergic responses in the civilian populations of Kuwait and Saudi Arabia. Roughly 18 percent of the civilian population of Kuwait suffer from some form of respiratory complaints, usually asthma, compared to about six percent in the United States.

For Gulf War veterans, the inhalation of ambient levels of particulate matter observed in the Kuwait theater of operations could have resulted in several acute symptoms and could have aggravated asthmatic conditions in some personnel.

"Typical short-term reversible symptoms were cold or flu-like and included cough, runny nose, eye and throat irritation, and shortness of breath. Skin exposures to sand and soot may have produced similar symptoms as well. Anecdotal information suggests that some service members experienced rashes, scaling, and skin irritation," said Shaughnessy.

Based on analyses, investigators determined that the risk of adverse long-term health effects from the exposure to be minimal. Many of the symptoms are short-lived and reversible.

While the soot from the oil fires were a large contributor to the particulate matter levels, post-war analysis collected by the U.S. Army Environmental Hygiene Agency determined that more than 70 percent of the particulate matter measured originated from the sand that was common to the area. Because many U.S. troops spent much of their time in the desert, health specialists were concerned about the possible adverse health effects on U.S. troops associated with exposure to high levels of blowing and suspended sand. For some personnel with respiratory problems, the fine blowing sand did aggravate their symptoms.

However, not all of the respiratory complaints experienced by Gulf War veterans result from exposure to high particulate matter levels. Investigators found that epidemiological surveys determined that respiratory symptoms were more common among the troops who worked and slept in air-conditioned buildings than among those who lived in tents or open warehouses.

Investigators conducted exposure assessments to examine the possible adverse health effects from exposure to particulate matter by Gulf War veterans. When making assessments of potential long-term or chronic effects from the inhalation of particulate matter both cumulative and total doses, must be taken into consideration. The methodology used to make the assessments estimates the cumulative exposure to which an individual is exposed and the total dosage, that is, the amount actually absorbed by the human body, that the individual accumulates over the period of exposure. Investigators concluded that the cumulative exposure and the total body burden dosages were below

the general guidelines established by the EPA for the protection of human health and, therefore, chronic health effects would not be expected.

Although the results of the literature search and health risk analyses conducted during the course of this investigation suggest that long-term adverse health effects are not likely, investigators have recommended more research into understanding the potential long-term health problems in soldiers exposed to respirable desert dust and other pollutants. Additionally, researchers would like more information about the physical, chemical and/or biological properties of particles that might cause adverse health effects and how these particulates might interact with other contaminants to present a more potent health threat.

Veterans with new or additional information should call the direct Veteran's Hotline at (800) 497-6261. Additionally, any veterans desiring a free, in-depth medical examination should call the DoD's Comprehensive Clinical Evaluation Program at (800) 796-9699 or the Department of Veterans Affair's Persian Gulf Registry toll-free number at (800) 749 - 8387 to enroll.