SESSION TITLE: Occupational/Environmental Lung Disease Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM
PURPOSE: We sought to characterize objective findings on lung function testing and high resolution computed tomography (HRCT) in a large cohort of service members who deployed to Afghanistan or Iraq (South West Asia (SWA)).
METHODS: Retrospective review of patients referred for lung function testing following deployment to SWA. Symptoms and baseline clinical characteristics were abstracted along with spirometry, diffusion capacity (DLCO), DLCO adjusted for volume (KCO), body plethysmography, HRCT and bronchoprovocation (BP) testing.
RESULTS: 717 patients had spirometry performed and 182 had DLCO. Mean age and BMI were 39.3±10 and 28.3±4.1 respectively, 78.5% were male, 61.9% were Caucasian and dyspnea on exertion was the most common presenting complaint. There were 329 (50.9%) patients with abnormal spirometry and most were mild (234 (72.0%)) to moderate (36 (11.1%)) in severity. DLCO and KCO were abnormal in 16 (8.7%) and 4 (2.2%) respectively. Of the 48 patients with abnormal spirometry at baseline and serial testing 64.6% normalized over time. Only 10 (6.6%) had a significant response to bronchodilator and 10 (21.3%) had positive BP tests. Total lung capacity was decreased in 7 (36.8%). Patients with HRCT had no significant parenchymal disease identified. There were no significant differences in spirometry, DLCO or KCO comparing patients with cough or dyspnea to those who denied both symptoms.
CONCLUSIONS: In conclusion, mild abnormalities on baseline spirometry were common in service members who were deployed to SWA. We were not able to identify a consistent pattern on lung function testing, but a portion of the patients would appear to have airway disease. Many normalized over time while others, particularly those with a restrictive pattern, did not.
CLINICAL IMPLICATIONS: Symptoms did not correlate with abnormalities on spirometry, highlighting the need for evaluation of disease outside of the respiratory system. In agreement with others we found little evidence for lung damage beyond the level of the airway. Assessment for small airway disease is indicated for the symptomatic patient with normal spirometry. Although we would caution against requiring specific testing regardless of clinical presentation and response to treatment, an aggressive and targeted work-up for the patient with persistent respiratory limitations following deployment is still prudent.
DISCLOSURE: The following authors have nothing to disclose: Michal Sobieszczyk, Dr. Michael Perkins, Dr. Robert Liotta, Paul Holley, Dr. John Sherner, Aaron Holley
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