Medical Co-morbidities of VCD in the military

1. Medical Co-morbidities of VCD in the military Joyce Gurevich-Uvena Joseph Parker Thomas Fitzpatrick Matthew Makashay Michelle Perello Elizabeth Blair Nancy Pearl Solomon Department of Internal Medicine Pulmonary Critical Care Department of Surgery Army Audiology and Speech Center Otolaryngology Head and Neck Service

2. 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)

3. Background More common in females than males 3.2:1 (Brugman, 2003) Paucity of data on VCD in military population

4. 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 (2.3:1) VCD negative: 10 females, 20 males (0.5:1) Mikita & Parker (2006) 25 patients diagnosed with VCD 12 women, 13 men

5. 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)

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

7. 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

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

9. Methods 265 consecutive patients from 1996-2001 diagnosed with VCD

10. Methods Referred to Speech Pathology Clinic

11. Methods Selected data Age Gender Service Distribution Service Status Rank Compiled database in Excel GERD Asthma Allergies PND

12. Results

13. Age

14. Gender Female 171 Male 94 Female:Male (1.8:1)*

15. Service Distribution

16. Service Status

17. Service Status by Gender

18. Active-Duty Rank/Pay Grade

19. VCD and Co-Morbidities

20. Number of Co-Morbidities

21. Number of Co-Morbidities for Active vs. Non-Active Duty

22. Summary of Demographics 265 patients referred to WRAMC 65% female, 35% male (1.8:1) 48% active duty Female:male ratio differed between active (1.2:1) and non-active duty (2.8:1)

23. 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)

24. 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.