Screening Spirometry in Military Personnel Correlates Poorly with Exercise Tolerance and Asthma History.

Autor: Anderson DMF; Pulmonary/Critical Care Service, Brooke Army Medical Center, 3551 Roger Brooke Dr, MCHE-ZDM-P, JBSA Fort Sam Houston, TX., Ondrasik NR; Pulmonary/Critical Care Service, Madigan Army Medical Center, 9040 Jackson Ave, JB Lewis-McChord, WA., Rawlins FA; Pulmonary/Critical Care, Keesler Medical Center, 500 Fisher St, Keesler AFB, MS., Lospinoso JA; Portia Statistical Consulting LLC, San Antonio, TX., Zanders TB; Pulmonary/Critical Care, St. Luke's University Health Network, Bethlehem, PA., Morris MJ; Pulmonary/Critical Care Service, Brooke Army Medical Center, 3551 Roger Brooke Dr, MCHE-ZDM-P, JBSA Fort Sam Houston, TX.
Jazyk: angličtina
Zdroj: Military medicine [Mil Med] 2018 Sep 01; Vol. 183 (9-10), pp. e562-e569.
DOI: 10.1093/milmed/usx195
Abstrakt: Background: Spirometry is an easy-to-perform test for evaluating pulmonary symptoms but has several limitations to include adequate test performance for valid results. Spirometry is not recommended to screen a general population for evidence of pulmonary disease unless symptoms are present or longitudinal screening is done for potential occupational exposures.
Methods: A single-spirometry examination was performed on 900 active duty Army soldiers, ages 18-35 yr, without documented respiratory disease. Abnormal studies were identified (obstructive, restrictive, mixed, and flow volume loop abnormalities) and compared with reported respiratory symptoms, smoking history, prior diagnosis of asthma, and failure of the Army physical fitness test 2-mile run using generalized linear modeling techniques.
Results: The cohort population had spirometry values comparable with published NHANES III reference values. Ninety-eight subjects (10.9%) were identified with abnormal spirometry included 33 obstructive, 44 restrictive, 3 mixed, and 18 isolated flow volume loop abnormalities. Historical features (smoking, exertional dyspnea, cough, asthma, or APFT failure) had no effect on the probability of an abnormal spirometry result (p = 0.56). Although APFT failure probability is strongly affected by exertional dyspnea (p = 0.00) and current smoking (p = 0.01), abnormal spirometry results did not have a statistically significant effect (p = 0.38).
Discussion: For potential screening of military personnel with spirometry to detect pulmonary disease, study findings identified a significant percentage with non-specific abnormalities requiring further evaluation. Spirometry may be indicated in those individuals with a history of asthma or active dyspnea symptoms. Spirometry as a screening tool is poorly (and often incorrectly) predictive for respiratory symptoms or decreased exercise tolerance in a military cohort.
Conclusion: Spirometry should not be used to screen the military force for the presence of respiratory disorders. In those individuals with a history of asthma, in-depth testing should be performed to fully evaluate any non-specific findings identified during spirometry.
(Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2018.)
Databáze: MEDLINE
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