Chest
Original ResearchHigh Levels of Medical Utilization by Ambulatory Patients With Vocal Cord Dysfunction as Compared to Age- and Gender-Matched Asthmatics
Section snippets
Methods and Materials
We investigated all patients aged > 18 years old who underwent diagnostic laryngoscopy between January 2002 and February 2004 in the Pulmonary Disease Clinic at Walter Reed Army Medical Center. Diagnosis of VCD was made if laryngoscopy revealed inappropriate adduction of the true vocal cords during respiration as described by Wood and Milgrom.8 Subjects with VCD were then matched for age (± 3 years) and gender to control patients with moderate persistent asthma.9 The case control group was
Results
The demographics and spirometry results for all subjects included in the study are depicted in Table 1. Thirteen male and 12 female VCD patients with a mean age of 41 years (range, 27 to 69 years) met inclusion criteria and were successfully age- and gender-matched to asthmatic control patients. The two cohorts did not differ significantly with regard to smoking status and comorbidities of heart disease (n = 1 vs n = 2, respectively; p < 0.5), malignancy (n = 1 vs n = 1; p < 0.5), liver disease
Discussion
Given our role in determining soldier fitness for duty, we have adopted an aggressive evaluation for the etiology of unexplained dyspnea. Patients typically are studied with routine spirometry before and after bronchodilator, followed by methacholine challenge and eucapnic voluntary hyperventilation bronchoprovocation tests, and finally cardiopulmonary exercise tests when indicated. Diagnostic laryngoscopy is performed if this evaluation does not yield a diagnosis and there is concern for VCD.
Conclusion
Ambulatory patients with undiagnosed VCD have significantly more physician and subspecialty care visits than patients with moderate persistent asthma, a group known to have high medical utilization. Frequent health-care visits and multiple prescriptions may be useful markers for suspected VCD as well as discriminators from asthmatics. Aggressive diagnosis and management of ambulatory VCD patients may have a significant impact on health-care utilization. Further investigation of diagnostic
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Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).
This work was performed at Walter Reed Army Medical Center, Washington, DC.