Evaluation of Exertional Dyspnea in the Active Duty Patient: The Diagnostic Approach and the Utility of Clinical Testing

Abstract

Various forms of obstructive lung disease and vocal cord dysfunction were the most common findings in this group. The routine use of spirometry and bronchoprovocation testing is warranted, but other tests, such as full PFT, CXR, and cardiac and laboratory evaluations, have limited diagnostic value in this population.

Prevalence of Supranormal Pulmonary Function Test Values Between a Military and Nonmilitary Cohort

“…The results are shown in Table 3 and demonstrate statistical differences in actual FEV 1 and FVC between the AD and non-AD groups (P Ͻ .001). However, when calculated using Z scores, there is normal distribution of both FEV 1 and FVC, with P ϭ .15 and .36, respectively.…”

“…The AD population was comprised of a higher percentage of male patients (57% male versus 43% female). Analysis for differences in PFT values (FVC, FEV 1 , and FEV 1 /FVC) for both males and females between groups demonstrated significance for FEV 1 and FEV 1 /FVC (P Ͻ .001). Post hoc analysis again yielded no significant difference when the gender-based AD 18 -50-year age group was compared with the non-AD 18 -50-year age group for both FEV 1 and FVC.…”

“…Specific note was also made for patients with either FEV 1 or FVC Ͼ 120% of predicted. The percentage of percent-of-predicted values (110% and 120%) that were above the calculated 95% CI based on the NHANES III upper limit of normal for FEV 1 and FVC was also determined for the included studies. From these studies, the following information was obtained: (1) patient demographics (age, gender, ethnicity, and height); (2) patient military status (AD, retired, or military dependent); (3) spirometry results (actual, predicted, and % of predicted) to include FEV 1 , FVC, and FEV 1 /FVC; and (4) if performed, total lung capacity (TLC), residual volume (RV), and diffusing capacity for carbon monoxide (D LCO ).…”

“…A final analysis was also performed to evaluate for any differences in PFT values based on gender or ethnicity. To compare the actual FEV 1 and FVC for AD and non-AD across ages 18 -50 y, a Z score was calculated for all patients. The Z score was calculated by taking each patient's absolute FEV 1 and FVC measures, subtracting the mean, and dividing by the SD, with respect to their gender and age group (18 -20, 21-30, 31-40, and 41-50 y).…”

“…Twenty-five percent of AD military personnel with complaints of exertional dyspnea had a negative comprehensive evaluation. 1 Given the recent emphasis on post-deployment respiratory symptoms and the possible relationship with environmental exposures such as sand storms and burn pits, many military personnel being evaluated for respiratory symptoms are found to have normal baseline PFTs. 2,3 Some clinicians have theorized that the AD military population, with a high level of emphasis on regular physical fitness compared with their non-AD counterparts, has a larger proportion of supranormal PFT values.…”