Chest
Volume 129, Issue 4, April 2006, Pages 905-908
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Original Research
High Levels of Medical Utilization by Ambulatory Patients With Vocal Cord Dysfunction as Compared to Age- and Gender-Matched Asthmatics

https://doi.org/10.1378/chest.129.4.905Get rights and content

Study objectives

To evaluate medical utilization by ambulatory patients with vocal cord dysfunction (VCD).

Design

Retrospective, case-control study.

Setting

Pulmonary disease clinic at an army tertiary-care center.

Patients

Twenty-five ambulatory patients with VCD (mean age, 41 years; range, 27 to 69 years) who were age- (± 3 years) and gender-matched to 25 control patients with moderate persistent asthma.

Measurements and results

Medical utilization for the year preceding the diagnosis of VCD or asthma was obtained from a computerized medical record. End points included total outpatient visits, evaluations by subspecialty physicians, presentations for urgent care, hospitalizations, and number of prescriptions. Total physician visits (477 visits vs 267 visits, respectively; p < 0.004) and subspecialty care visits (277 visits vs 118 visits; p < 0.007) were significantly greater among the VCD cohort as compared with the asthmatic cohort. The groups were also found to have comparable utilization of prescriptions (448 prescriptions vs 394 prescriptions, respectively; p < 0.63), frequency of hospitalizations (seven hospitalizations vs five hospitalizations; p < 0.59), and urgent care visits (45 visits vs 20 visits; p < 0.14).

Conclusions

Ambulatory VCD patients use significantly more medical provider resources and similar pharmaceutical assets as compared to patients with moderate persistent asthma.

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.

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