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Consensus Statements on Deployment-Related Respiratory Disease, Inclusive of Constrictive Bronchiolitis A Modified Delphi Study
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3 2023
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Source: Chest. 163(3):599-609
[PDF-1010.63 KB]
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Alternative Title:Chest
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Personal Author:
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Description:BACKGROUND:
The diagnosis of constrictive bronchiolitis (CB) in previously deployed individuals, and evaluation of respiratory symptoms more broadly, presents considerable challenges, including using consistent histopathologic criteria and clinical assessments.
RESEARCH QUESTION:
What are the recommended diagnostic workup and associated terminology of respiratory symptoms in previously deployed individuals?
STUDY DESIGN AND METHODS:
Nineteen experts participated in a three-round modified Delphi study, ranking their level of agreement for each statement with an a priori definition of consensus. Additionally, rank-order voting on the recommended diagnostic approach and terminology was performed.
RESULTS:
Twenty-five of 28 statements reached consensus, including the definition of CB as a histologic pattern of lung injury that occurs in some previously deployed individuals while recognizing the importance of considering alternative diagnoses. Consensus statements also identified a diagnostic approach for the previously deployed individual with respiratory symptoms, distinguishing assessments best performed at a local or specialty referral center. Also, deployment-related respiratory disease (DRRD) was proposed as a broad term to subsume a wide range of potential syndromes and conditions identified through noninvasive evaluation or when surgical lung biopsy reveals evidence of multicompartmental lung injury that may include CB.
INTERPRETATION:
Using a modified Delphi technique, consensus statements provide a clinical approach to possible CB in previously deployed individuals. Use of DRRD provides a broad descriptor encompassing a range of postdeployment respiratory findings. Additional follow-up of individuals with DRRD is needed to assess disease progression and to define other features of its natural history, which could inform physicians better and lead to evolution in this nosology.
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Pubmed ID:36343686
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Pubmed Central ID:PMC10154857
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Volume:163
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Issue:3
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