Respiratory Care |

Retrospective Validation of Screening Studies to Detect Vocal Cord Dysfunction FREE TO VIEW

Nathan Boyer, MD; Michael Morris, MD; Kenneth Kemp, MD
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Brooke Army Medical Center, Fort Sam Houston, TX

Chest. 2014;146(4_MeetingAbstracts):906A. doi:10.1378/chest.1990775
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SESSION TITLE: Non-Ventilatory Respiratory Support

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 27, 2014 at 04:30 PM - 05:30 PM

PURPOSE: Vocal cord dysfunction (VCD) is a commonly diagnosed syndrome characterized by paradoxical true vocal cord adduction with inspiration. Although the pathophysiology of abnormal glottic movement is poorly elucidated, multiple different etiologies such as exercise, airway irritants or psychiatric disorders predispose to laryngeal hyperresponsiveness. Identifying patients with this syndrome may be difficult unless having acute symptoms.

METHODS: We conducted a retrospective analysis of patients seen in the allergy or pulmonary clinics within military medical centers between January 2005 and December 2011 with ICD-9 codes related to laryngeal disorders or underwent laryngoscopy. Primary outcomes included rates of VCD, associated risk factors (GERD, allergic rhinitis, psychiatric disorders) and associated asthma. Other outcomes assessed differences in PFTs, flow volume loops and bronchoprovocation testing based on a VCD diagnosis.

RESULTS: Preliminary analysis identified 960 patients of which 345 (36%) were diagnosed VCD by direct laryngoscopy. The overall cohort was predominantly male (65%) due to military demographics. When comparing patients with diagnosed VCD versus the remaining patients, there was no significant difference between FEV1 (% pred) values, 91% vs 92%, (p=0.11), FEV1/FVC ratio, 81% vs 80% (p=0.72), or rates of abnormal bronchoprovocation testing at 29% in both groups (p=0.10). Similar rates of diagnosed asthma, 43% versus 46% (p=0.36) were also seen. There were significantly higher rate of both PTSD, 4% vs. 0.1%, (p=0.04), and GERD, 54% vs. 44%, (p= 0.01) in patients with VCD.

CONCLUSIONS: This is the largest retrospective analysis of patients evaluated for suspected VCD. Clinical evaluation based on PFT values or reactive bronchoprovocation testing did not discriminate patients between patients with and without VCD in this cohort. Underlying disorders such as GERD or PTSD may be more predictive of patients with underlying laryngeal hyperresponsiveness eventually diagnosed with VCD. These findings correlate with current literature on the utility of PFT in VCD patients.

CLINICAL IMPLICATIONS: In patients who are not responsive with treatment for pulmonary disorders such as asthma or exercise induced bronchospasm (EIB), additional evaluation with laryngoscopy may be warranted.

DISCLOSURE: Michael Morris: Consultant fee, speaker bureau, advisory committee, etc.: Spiriva The following authors have nothing to disclose: Nathan Boyer, Kenneth Kemp

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