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Pulmonary Physiology |

Evaluation of Upper Airway Disorders in Military Personnel With Postdeployment Dyspnea

Damon Forbes, MD; Andrew Skabelund, MD; Jacob Collen, MD; Pedro Lucero, MD; Michael Morris, MD
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San Antonio Uniformed Services Health Education Consortium, San Antonio, TX


Chest. 2015;148(4_MeetingAbstracts):891A. doi:10.1378/chest.2280772
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Abstract

SESSION TITLE: Pulmonary Physiology Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Over the past decade numerous studies have raised concern for pulmonary disorders emerging among military personnel deployed to Southwest Asia. Thus far, asthma and airway hyperreactivity have been the most commonly diagnosed conditions in this setting. The role of laryngoscopy and bronchoscopy in identifying upper airway disorders in this population has not been previously described.

METHODS: Military personnel referred for respiratory complaints following deployment were enrolled in a standardized evaluation consisting of allergy testing, echocardiography, chest imaging and pulmonary function testing (spirometry, lung volumes, diffusing capacity, impulse oscillometry, methacholine, and cardiopulmonary exercise testing). The upper and lower airways were evaluated with exercise laryngoscopy and bronchoscopy with bronchoalveolar lavage.

RESULTS: Evaluations of 108 patients have been completed to date (89% male, mean age 37.6 ± 9.3 years, mean body mass index 28.6 ± 3.9 kg/m2). One-third of the cohort actively smoked cigarettes and had smoked during deployment. Upper airway disorders were identified in 24 patients by airway endoscopy. Ten patients were diagnosed with inducible laryngeal obstructions (nine with vocal cord dysfunction, one with arytenoid collapse), eleven patients had evidence of gastroesophageal reflux for which treatment was initiated, and three patients had excessive dynamic airway collapse involving the large airways. Spirometry revealed a mean FEV1 of 91.4 ± 16.4 % predicted and FVC of 88.0 ± 16.5 % predicted with FEV1/FVC of 76.9 ± 7.8%. Total lung capacity (96.8 ± 6.1%) and diffusing capacity (99.4 ± 17.9%) were also normal. Resting flow volume loops were notable for inspiratory limb flattening in five patients.

CONCLUSIONS: Upper airway disorders were identified in 22% of patients presenting with respiratory complaints following combat deployment. Airway endoscopy significantly augmented the evaluation of deployment related pulmonary disorders and altered management of dyspnea symptoms.

CLINICAL IMPLICATIONS: Strong consideration should be given to performing endoscopic evaluation of the upper airway to rule out laryngeal disorders and grade the larynx for the presence of reflux disease.

DISCLOSURE: The following authors have nothing to disclose: Damon Forbes, Andrew Skabelund, Jacob Collen, Pedro Lucero, Michael Morris

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