{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T23:18:16Z","timestamp":1790032696140,"version":"4.0.1"},"reference-count":40,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2021,2,23]],"date-time":"2021-02-23T00:00:00Z","timestamp":1614038400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Burn pits (BPs) have been widely used by the U.S. military for waste disposal while in conflicts abroad. Significant adverse health effects are thought to be linked to BPs, but limited data exist examining the impact on the respiratory tract. The purpose of this systematic review is to characterize these effects on both the upper respiratory tract (URT) and lower respiratory tract (LRT).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines on articles published from January 1, 2001, through November 2020. PubMed, EMBASE, and Ovid MEDLINE databases were queried for studies examining the effect of BPs on the URT and LRT of service members.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 288 articles were identified, with nine meeting inclusion criteria. Eight of the nine articles assessed the LRT, one examined the URT alone, and two examined both the URT and LRT. Outcome measures were heterogeneous across all studies, precluding meta-analysis. Patient-reported LRT diagnoses appeared to increase as exposure to BPs increased. There are very limited data assessing the impact of BP exposure on the URT. No association between BP exposure and objective measures of LRT or URT disease was identified.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Service members deployed to combat zones seem to report a significant increase in respiratory diseases following exposure to BPs, although definitive conclusions are limited by multiple airborne exposures and varied reporting methods. Self-reported LRT diagnoses appear to be more prevalent. There is a paucity of data on the effects of BPs on the URT. Objective measures of disease do not appear to correlate with patient reports. Prospective, long-term, and outcome-based studies are necessary to examine the effects of BPs, and other airborne hazards related to deployment, on the URT and LRT of service members.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usab070","type":"journal-article","created":{"date-parts":[[2021,2,23]],"date-time":"2021-02-23T12:03:31Z","timestamp":1614081811000},"source":"Crossref","is-referenced-by-count":11,"title":["The Potential Effects of Burn Pit Exposure on the Respiratory Tract: A Systematic Review"],"prefix":"10.1093","author":[{"given":"James","family":"McLean","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, James A. Lovell Federal Health Care Center, North Chicago, IL 60064, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Capra","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles A","family":"Riley","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology\u2014Head and Neck Surgery, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA"},{"name":"Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,2,23]]},"reference":[{"key":"2021022311584294000_R1","first-page":"1","article-title":"Department of defense Armed forces health surveillance center","volume-title":"Epidemiological Studies of Health Outcomes among Troops Deployed to Burn Pit Sites","author":"The Armed Forces Health Surveillance Center, The Naval Health Research Center, The U.S. Army Public Health Command (Provisional)","year":"2010"},{"issue":"5","key":"2021022311584294000_R2","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1097\/JOM.0b013e318042d682","article-title":"Health and exposure concerns of veterans deployed to Iraq and Afghanistan","volume":"49","author":"Helmer","year":"2007","journal-title":"J Occup Med"},{"issue":"4","key":"2021022311584294000_R3","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1080\/08958370802672891","article-title":"Potential health implications associated with particulate matter exposure in deployed settings in Southwest Asia","volume":"21","author":"Weese","year":"2009","journal-title":"Inhal Toxicol"},{"issue":"10","key":"2021022311584294000_R4","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.7205\/MILMED-D-10-00436","article-title":"Investigating the respiratory health of deployed military personnel","volume":"176","author":"Morris","year":"2011","journal-title":"Mil Med"},{"key":"2021022311584294000_R5","article-title":"Occupational lung diseases among soldiers deployed to Iraq and Afghanistan","volume":"1","author":"Szema","year":"2013","journal-title":"Occup Med Health Aff"},{"issue":"3","key":"2021022311584294000_R6","first-page":"243","article-title":"Iraq dust is respirable, sharp, and metal-laden and induces lung inflammation with fibrosis in mice via IL-2 upregulation and depletion of regulatory T cells","volume":"56","author":"Szema","year":"2014","journal-title":"J Occup Med"},{"issue":"34","key":"2021022311584294000_R7","first-page":"33901","article-title":"Particulate matter air pollution and respiratory impact on humans and animals","volume":"25","author":"Losacco","year":"2018","journal-title":"Environ Sci Pollut Res Int"},{"issue":"1\u20133","key":"2021022311584294000_R8","first-page":"95","article-title":"Air pollution combustion emissions: characterization of causative agents and mechanisms associated with cancer, reproductive, and cardiovascular effects","volume":"636","author":"Lewtas","year":"2007","journal-title":"Mutat Res"},{"issue":"5","key":"2021022311584294000_R9","first-page":"392","article-title":"Airborne particulate matter: human exposure and health effects","volume":"60","author":"Thompson","year":"2018","journal-title":"J Occup Environ Med"},{"key":"2021022311584294000_R10","article-title":"Afghanistan and Iraq. DoD should improve adherence to its guidance on open pit burning and solid waste management","author":"Government Accountability Office","year":"2010"},{"key":"2021022311584294000_R11","first-page":"116","article-title":"Airborne hazards exposure and respiratory health of Iraq and Afghanistan veterans","volume":"37","author":"Falvo","year":"2015","journal-title":"Epidemiol Rev"},{"issue":"2\u201316","key":"2021022311584294000_R12","first-page":"173","article-title":"Deployment-related respiratory issues","author":"Morris","year":"2016","journal-title":"US Army Med Dep J"},{"issue":"11","key":"2021022311584294000_R13","first-page":"1433","article-title":"Newly reported respiratory symptoms and conditions among military personnel deployed to Iraq and Afghanistan: a prospective population-based study","volume":"170","author":"Smith","year":"2009","journal-title":"Am J Epidemiol"},{"issue":"5","key":"2021022311584294000_R14","first-page":"67","article-title":"New-onset asthma among soldiers serving in Iraq and Afghanistan","volume":"31","author":"Szema","year":"2010","journal-title":"Allergy Asthma Proc"},{"issue":"5","key":"2021022311584294000_R15","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1016\/j.ijsu.2010.02.007","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"8","author":"Moher","year":"2010","journal-title":"Int J Surg"},{"key":"2021022311584294000_R16","article-title":"PRISMA transparent reporting of systematic reviews and meta-analyses","year":"2020"},{"key":"2021022311584294000_R17","article-title":"Levels of evidence (March 2009)","author":"Oxford Centre for Evidence-Based Medicine","year":"2020"},{"issue":"1","key":"2021022311584294000_R18","first-page":"77","article-title":"Study of active duty military for pulmonary disease related to environmental deployment exposures (STAMPEDE)","volume":"190","author":"Morris","year":"2014","journal-title":"Am J Respir Crit Care Med"},{"issue":"6","key":"2021022311584294000_R19","first-page":"708","article-title":"The effects of exposure to documented open-air burn pits on respiratory health among deployers of the Millennium Cohort Study","volume":"54","author":"Smith","year":"2012","journal-title":"J Occup Environ Med"},{"issue":"5","key":"2021022311584294000_R20","first-page":"540","article-title":"A retrospective cohort study of military deployment and postdeployment medical encounters for respiratory conditions","volume":"179","author":"Abraham","year":"2014","journal-title":"Mil Med"},{"issue":"7","key":"2021022311584294000_R21","first-page":"e249","article-title":"Burn pit emissions exposure and respiratory and cardiovascular conditions among airborne hazards and open burn pit registry participants","volume":"58","author":"Liu","year":"2016","journal-title":"J Occup Med"},{"issue":"Suppl 8","key":"2021022311584294000_R22","first-page":"S104","article-title":"Assessing health outcomes after environmental exposures associated with open pit burning in deployed US Service members","volume":"58","author":"Rohrbeck","year":"2016","journal-title":"J Occup Environ Med"},{"issue":"3\u20134","key":"2021022311584294000_R23","first-page":"e389","article-title":"Exercise-induced bronchoconstriction in Iraq and Afghanistan Veterans with deployment-related exposures","volume":"185","author":"Klein-Adams","year":"2020","journal-title":"Mil Med"},{"issue":"6","key":"2021022311584294000_R24","first-page":"1559","article-title":"Clinical evaluation of deployed military personnel with chronic respiratory symptoms: Study of Active Duty Military for Pulmonary Disease Related to Environmental Deployment Exposures (STAMPEDE) III","volume":"157","author":"Morris","year":"2020","journal-title":"Chest"},{"key":"2021022311584294000_R25","volume-title":"Sleep Breath","author":"Powell","year":"2020"},{"issue":"9","key":"2021022311584294000_R26","article-title":"A pilot study of airborne hazards and other toxic exposures in Iraq War Veterans","volume":"17","author":"Poisson","year":"2020","journal-title":"Int J Environ Res Public Health"},{"issue":"5","key":"2021022311584294000_R27","first-page":"476","article-title":"Increasing prevalence of chronic lung disease in veterans of the wars in Iraq and Afghanistan","volume":"181","author":"Pugh","year":"2016","journal-title":"Mil Med"},{"issue":"12","key":"2021022311584294000_R28","first-page":"1175","article-title":"Lifetime prevalence of respiratory diseases and exposures among veterans of Operation Enduring Freedom and Operation Iraqi Freedom veterans: results from the National Health Study for a new generation of U.S. veterans","volume":"58","author":"Barth","year":"2016","journal-title":"J Occup Med"},{"key":"2021022311584294000_R29","volume-title":"Emissions from Simulated Open Burning of Deployed US Military Waste","author":"Woodall","year":"2012"},{"key":"2021022311584294000_R30","article-title":"Combat zone exposure and respiratory tract disease","author":"Parsel","journal-title":"Int Forum Allergy Rhinol"},{"issue":"3","key":"2021022311584294000_R31","first-page":"261","article-title":"Sinonasal pathology in nonallergic asthma and COPD: \u2018united airway disease\u2019 beyond the scope of allergy","volume":"63","author":"Hens","year":"2008","journal-title":"Allergy"},{"key":"2021022311584294000_R32","first-page":"93","article-title":"United airway disease: current perspectives","volume":"9","author":"Giavina-Bianchi","year":"2016","journal-title":"J Asthma Allergy"},{"issue":"5","key":"2021022311584294000_R33","first-page":"337","article-title":"Respiratory diseases in post-9\/11 military personnel following Southwest Asia deployment","volume":"62","author":"Krefft","year":"2020","journal-title":"J Occup Environ Med"},{"key":"2021022311584294000_R34","volume-title":"Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan","author":"Institute of Medicine","year":"2011"},{"key":"2021022311584294000_R35","volume-title":"Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry","author":"National Academies of Sciences, Engineering, and Medicine","year":"2017"},{"key":"2021022311584294000_R36","volume-title":"Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations","author":"National Academies of Sciences, Engineering, and Medicine","year":"2020"},{"key":"2021022311584294000_R37","article-title":"Final assessment: what we have learned from our inspections of incinerators and use of burn pits in Afghanistan","author":"Special Inspector General for Afghanistan Reconstruction","year":"2015"},{"key":"2021022311584294000_R38","article-title":"Open burn pit report to congress","author":"Department of Defense","year":"2019"},{"issue":"6","key":"2021022311584294000_R39","first-page":"539","article-title":"Cigarette smoking and military deployment: a prospective evaluation","volume":"35","author":"Smith","year":"2008","journal-title":"Am J Prev Med"},{"issue":"1","key":"2021022311584294000_R40","doi-asserted-by":"crossref","DOI":"10.7205\/MILMED-D-12-00449","article-title":"Tobacco product usage among deployed male and female military personnel in Kuwait","volume":"178","author":"DiNicola","year":"2013","journal-title":"Mil Med"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usab070\/36339682\/usab070.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usab070\/36339682\/usab070.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,23]],"date-time":"2021-02-23T12:03:43Z","timestamp":1614081823000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article\/doi\/10.1093\/milmed\/usab070\/6146879"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,23]]},"references-count":40,"URL":"https:\/\/doi.org\/10.1093\/milmed\/usab070","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,23]]},"article-number":"usab070"}}