Medical Comorbidities of VCD in the military

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Medical Co-morbidities of VCD in the military

• Department of Internal Medicine
• Pulmonary Critical Care
• Department of Surgery
• Army Audiology and Speech Center
• Otolaryngology Head and Neck Service

• Joyce Gurevich-Uvena
• Joseph Parker
• Thomas Fitzpatrick
• Matthew Makashay
• Michelle Perello
• Elizabeth Blair
• Nancy Pearl Solomon

Walter Reed Army Medical Center, Washington DC
The views expressed are those of the authors and
do not reflect the official policy of the
Department of the Army, the Department of Defense
or the US Government.
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Background

• Common co-morbidities
• Asthma
• GERD
• Allergies PND
• Chronic rhinosinusitis
• (Balkissoon, 2007 Brugman, 2003 Doshi
  Weinberger, 2004 Mikita Mikita, 2006 Mikita
  Parker, 2006 Newman, Mason Schmaling, 1995)

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Background

• More common in females than males
• 3.21 (Brugman, 2003)
• Paucity of data on VCD in military population

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VCD Studies in the Military

• Craig, Sitz, Squire, Smith, Carpenter (1992)
• 2 women, psychogenic
• Morris, Deal, Bean, Grbach, Morgan (1999)
• 40 active duty military with exertional dyspnea
• VCD positive 7 females, 3 males (2.31)
• VCD negative 10 females, 20 males (0.51)
• Mikita Parker (2006)
• 25 patients diagnosed with VCD
• 12 women, 13 men

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Background

• VCD Risk factors
• Strenuous exercise
• Psychological stress
• Military Factors
• Daily physical activity requirements
• Bi-annual Military Physical Fitness Test
• High stress, exacerbated during war-time
• (Craig et al., 1992 Morris et al., 1999)

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Rationale

• The incidence of the clinical characteristics of
  VCD are not well established in the military
  population.

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Purpose

• To describe the demographic characteristics of
  patients diagnosed with VCD seen at Walter Reed
  Army Medical Center
• To identify co-morbid conditions associated with
  VCD in these patients

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Methods

• Retrospective chart review
• Case history interview with speech-language
  pathologist
• Supplemented with diagnostic tests as available

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Methods

• 265 consecutive patients from 1996-2001 diagnosed
  with VCD

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Methods

• Referred to Speech Pathology Clinic

Referral Sources
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Methods

• Selected data
• Age
• Gender
• Service Distribution
• Service Status
• Rank
• Compiled database in Excel

• GERD
• Asthma
• Allergies
• PND

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Results
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Age
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Gender

• Female 171
• Male 94
• FemaleMale (1.81)

Females represent 10.8 of military
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Service Distribution
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Service Status
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Service Status by Gender
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Active-Duty Rank/Pay Grade
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VCD and Co-Morbidities
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Number of Co-Morbidities
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Number of Co-Morbidities for Active vs.
Non-Active Duty
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Summary of Demographics

• 265 patients referred to WRAMC
• 65 female, 35 male (1.81)
• 48 active duty
• Femalemale ratio differed between active (1.21)
  and non-active duty (2.81)

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Summary of Co-Morbidities

• Co-morbid conditions were common
• GERD (33)
• Allergies (32)
• Asthma (20)
• PND (15)
• 20 of patients presented with VCD alone
• 51 of patients had two or more co-morbidities
• Active-duty patients tended to have fewer
  co-morbidities than non-active duty patients
  (p.058)

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Conclusions

• WRAMC Speech Pathology Clinic has had a
  substantial number of referrals for VCD
• Referrals equally represented active and
  non-active duty patients
• Female to male ratio of patients with VCD in the
  military differs from other settings, presumably
  because of the predominantly male population
• GERD and allergies were the most common
  co-morbidities
• Reinforces the importance of assessing co-morbid
  factors and making appropriate referrals.