Occupational and Environmental Lung Diseases: Occupational and Environmental Lung Disease |

Impulse Oscillometry in the Evaluation of Post-Deployment Dyspnea: Preliminary Data From STAMPEDE III FREE TO VIEW

Nikhil Huprikar, MD; Andrew Skabelund, MD; Daniel Pearson, MD; Michael Morris, MD
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SAUSHEC, Fort Sam Houston, TX

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):934A. doi:10.1016/j.chest.2016.08.1035
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SESSION TITLE: Occupational and Environmental Lung Disease

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Studies of military personnel deployed to Southwest Asia in support of OIF/OEF have suggested increases in lung disease due to possible airborne environmental exposures such geologic dusts or burn pit smoke. Our initial prospective study (STAMPEDE) did not identify any acute interstitial or inflammatory processes in these personnel. An ongoing comprehensive evaluation (STAMPEDE III) is being conducted to identify the types of chronic respiratory disorders associated with deployment.

METHODS: All military personnel referred for deployed-related pulmonary symptoms underwent a standardized evaluation. Studies included allergy testing, HRCT imaging, ECG, and echocardiography. Pulmonary function testing consisted of full PFTs with LV, DLCO; post-BD testing, impulse oscillometry (IOS), and exhaled nitric oxide. Further diagnostic tests also included methacholine, laryngoscopy, cardiopulmonary testing, and bronchoscopy with bronchoalveolar lavage. Impulse oscillometry measures resistance (R5 and R20) and reactance (X5) using non-effort dependent sound wave frequencies.

RESULTS: Completed evaluations of the initial 196 patients have yielded a variety of diagnoses for their chronic symptoms that predominately include asthma, non-specific airway hyperreactivity (AHR) and inducible laryngeal obstruction. Patients are 90% male with a mean age of 38.0 ± 8.8 years and BMI of 28.6 ± 4.0 kg/m2. Average FEV1 (% pred) was 87.3 ± 16.7%; FVC (% pred) = 92.0 ± 15.0%; FEV1/FVC = 81.1 ± 6.6; with FEV1 (post-BD) = 92.2 ± 15%. Based on PFT interpretation, only 24% had evidence of obstruction, 13% with a post-BD response. Average IOS values were X5 = -1.38 ± 1.01; R5 (% pred) of 144 ± 53; and R20 (% pred) of 132 ± 38. Using pre-bronchodilator IOS values for comparison (X5 less than -1.5 or R5 > R20 > 150%); the percentage of abnormal baseline studies increased to 30%.

CONCLUSIONS: This comprehensive evaluation of post-deployment pulmonary symptoms identified a various chronic pulmonary diseases and several cardiac etiologies with asthma and AHR as the most common disease processes.

CLINICAL IMPLICATIONS: Preliminary data from this study suggests using IOS in conjunction with spirometry may identify more individuals with possible evidence of increased AHR.

DISCLOSURE: The following authors have nothing to disclose: Nikhil Huprikar, Andrew Skabelund, Daniel Pearson, Michael Morris

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