In this issue of CHEST (see page 905), Mikita and Parker1 demonstrate that ambulatory vocal cord dysfunction (VCD) patients, who likely had an underlying somatoform disorder, had significantly more physician visits and subspecialty visits (particularly pulmonary) during the year prior to their VCD diagnosis than matched control subjects with moderate persistent asthma, which is the disorder that VCD often mimics.
The VCD diagnostic approach of Mikita and Parker1 is impressive from two perspectives. Because of their role in determining soldier fitness for duty, they implemented an aggressive evaluation for unexplained dyspnea, typically including a comprehensive assessment for bronchial hyperreactivity. Consequently, they were able to exclude concomitant asthma in 84% of their 25 VCD patients. Ironically, the identified VCD patients were largely retirees and dependents rather than active duty military.