Required Spirometry Standard to avoid DQ?

LawyerLynn

LawyerLynn

Just a dad
5-Year Member
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My son had to get a spirometry as a remedial by DoDMERB due to a history of childhood asthma and a positive TB test with a lung nodule when he was younger. The physician said he did fine. However, DoDMERB is now listing him as DQ'd and says "D241.30 Asthma/reactive airway disease/exercise induced bronchospasm after age 13"

We called them and supposedly the spirometry test came back with a value of FEV1/FVC=74% pre-airway dilation which "does not meet medical standards" according to a note in his DoDMERB file.

According to the technician we spoke with it is this result that the DQ is based on and not his actual history which is clear with his doctor discontinuing ALL treatment for any asthma concerns by age 12 and a full TB clearance. My son can run a 5:09 mile, I don't think he could do that with active airway issues.

I know this is a bit technical, but does anyone know what IS the actual requirement for this measurement to meet medical standards? Would it help to get another spirometry from our own doctor and forward those results? I'd hate to see him lose his dream over a test result when what it is supposedly measuring is truly not an issue for him.

Thanks for any help.
 
I'm not 100% on this, but they are likely using normative data from the NHANES III study (a national health study) to set an aged based normal. In that study for a Caucasian in the high school years the normal is >84%.

I would get another one and submit it, it won't hurt (unless it's worse or the same obviously) and it could help.

Based on that one value your child would be classified as having some lung disease even though he runs a 5:09 mile.....imagine what he could do without the lung restriction :) if that was a properly performed test.

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Thoughts...

L-Lynn,

+1 kp2001... if you can locate a Dr. that deals or knows the Navy standards this could be very helpful.

My DS took this test with a Dr. that worked with Navy divers, he too looked at the data from the Navy standards. I cannot speak for the specific numbers; however, he did explain the differences and what is looked for. My DS test information along with the Dr. letter of being cleard was submitted which resulted in him being qualified.

DoDMERB may have your DS as DQ; however, there may be a possible waiver process if the Academy / NROTC board deem it.
 
A different test that was requested for my DS is the methacholine challenge. It is more complicated than the spirometry. My DS was never DQ'd, but given a remedial instead. Maybe ask about having this one done ... I've heard not all doctors like to do it, there are fewer places to have it done, it is more expensive....
  • Methacholine challenge test: This lung function test for asthma is more commonly used in adults than in children. It might be performed if your symptoms and screening spirometry do not clearly or convincingly establish a diagnosis of asthma. Methacholine is an agent that, when inhaled, causes the airways to spasm (contract involuntarily) and narrow if asthma is present. During this test, you inhale increasing amounts of methacholine aerosol mist before and after spirometry. The methacholine test is considered positive, meaning asthma is present, if the lung function drops by at least 20%. A bronchodilator is always given at the end of the test to reverse the effects of the methacholine.
 
You may want to check some past threads including those with Ex.BT.USN on the spirometry, he was proactive for his son and found qualified. They may be on DODMERB forum thread. Read many differing opinions on methacholine challenge regarding false positives. Keep us updated on forum.
 
All I can say is my DS wasn't given an option of one test over the other by DODMERB. With a childhood history of asthma (including multiple hospitalizations as an infant/toddler for pneumonia, RSV, and other asthma-inducing illnesses), he wasn't even DQ'd. He received a remedial and told to do the methacholine challenge. Because it is more expensive, I don't believe it is the go-to test for DODMERB, whereas the spirometry is. But because the methacholine challenge induces asthma-like symptoms, on a varying scale (medicine is given in different doses, but not necessarily in increasing amounts -- only the person administering the test knows the quantities, not the patient), it is a more intense test. Was just throwing it out there as an additional option to the OP.
 
Good news - got the results from the remedial that DoDMERB ordered, went to see our own pulmonologist to get a 2nd test or do the Methacoline Challenge test. He reviewed DoDMERB test results and refused to do another test and said the remedial test had been interpreted wrongly by DoDMERB. He wrote a short letter explaining that my DS results on the remdial were normal and showed no evidence of impaired lung function at all. We sent that letter to DoDMERB along with a pulmonary function test my son had at age 15 to qualify to play football which showed no impairment and similar results to that of DoDMERB's remedial exam. DoDMERB reviewed the material and the DQ Code (D241.30) was removed from his file. He just received an appointment to the Coast Guard Academy too and with this DQ code gone, looks like he may get in (he has another DQ code that will require a waiver, but we think he'll be ok there).
 
LawyerLynn said:
Good news - got the results from the remedial that DoDMERB ordered, went to see our own pulmonologist to get a 2nd test or do the Methacoline Challenge test. He reviewed DoDMERB test results and refused to do another test and said the remedial test had been interpreted wrongly by DoDMERB. He wrote a short letter explaining that my DS results on the remdial were normal and showed no evidence of impaired lung function at all. We sent that letter to DoDMERB along with a pulmonary function test my son had at age 15 to qualify to play football which showed no impairment and similar results to that of DoDMERB's remedial exam. DoDMERB reviewed the material and the DQ Code (D241.30) was removed from his file. He just received an appointment to the Coast Guard Academy too and with this DQ code gone, looks like he may get in (he has another DQ code that will require a waiver, but we think he'll be ok there).
Click to expand...

LawyerLynn,

If you don't mind sharing, others facing similar issues with spirometries in their history or remedials would likely benefit from seeing excerpts from the doctor's letter (that don't contain personally identifying info) discussing the standard applied by the doctor for defining "normal" for each of the values in the spirometry (particularly FEV1/FVC).
 
It appears LawyerLynn has not even been on the forum in a year and a half. More recent threads would probably yield better information.

Stealth_81
 
Just an FYI on the methacoline.... When my DS saw the Navy diver Dr. he was against the test. He said that the test could lead to a false positive. To that end he started with the spirometrie test. He said that if he could prove his case with whatever numbers he looked at the methacoline test would not be necessary. All that being said I'm an engineer not a Dr. so take my feed as only background feedback and maybe a resource for your own questions. I can only post what worked for my DS; I can't promise that this will work for all. All the best to all the kids that want this journey. As a parent I'm about to start this all over again with our DD.
 
I don't know if this helps but DoDMERB uses a spirometry performed in accordance with American Thoracic Society (ATS) guidelines and as defined by current National Heart, Lung, and Blood Institute (NHLBI) standards.
 
As someone who's also looking for answers on spiro and having a hard time finding answers, I'll leave some links here:
NHLBI Quick Care Reference:
Page 6 states that "well-controlled" asthma has an FEV1 of >80%. Obviously, we're looking for no asthma here, but this is still something to go from.
Also from the NHLBI (page 40 of a 417 page doc)
From the section on establishing a positive diagnosis: "Spirometry to demonstrate obstruction and assess reversibility... Reversibility is determined either by an increase in FEV1 of ≥12 percent from baseline or by an increase ≥10 percent of predicted FEV1 after inhalation of a short-acting bronchodilator."
I'm no doctor, but to the best of my knowledge much of the test comes from how high the FEV %s are in addition to how much a bronchodilator changes your results. For example, someone that goes from 92% to 96% FEV1 would most likely be in the clear (I sure hope so 'cause those are my numbers) while someone with, say, an 86% that jumps to the same 96% would have more of an issue.
Re: kp2001's NHANES III study:
TL;DR a 17yo 190cm white guy like me has a predicted: FEV1 of 4.94, FVC of 5.93, FEF of 5.02, and FEV1/FVC of 84.6
Again, I'm no doctor. Just thought I'd post the info here so others can find it.
 
Update to my previous post: now that DoDMERB's back up, I'm listed as qualified:
I passed spiro with 92% FEV1, 97% FEV1/FVC, and 93% FVC. I'm not actually sure which numbers they use, but those were before the bronchodilator so there wasn't much room for change.
Hope this helps as info on what gets a pass.
 
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