Consensus Statements on Deployment-Related Respiratory Disease, Inclusive of Constrictive Bronchiolitis A Modified Delphi Study

Details

• Alternative Title:
  Chest
• Personal Author:
  Falvo, Michael J. ; Sotolongo, Anays M. ; Osterholzer, John J. ; Robertson, Michelle W. ; Kazerooni, Ella A. ; Amorosa, Judith K. ; Garshick, Eric ; Jones, Kirk D. ; Galvin, Jeffrey R. ; Kreiss, Kathleen ; Hines, Stella E. ; Franks, Teri J. ; Miller, Robert F. ; Rose, Cecile S. ; Arjomandi, Mehrdad ; Krefft, Silpa D. ; Morris, Michael J. ; Polosukhin, Vasiliy V. ; Blanc, Paul D. ; D’Armiento, Jeanine M.
• 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.
  
  
• Subjects:
  Bronchiolitis Obliterans Delphi Technique Humans Lung Injury Respiration Disorders Respiratory Tract Diseases
• Keywords:
  Bronchiolitis Delphi Technique Dyspnea Environmental Exposure Military Deployment
• Source:
  Chest. 163(3):599-609
• Pubmed ID:
  36343686
• Pubmed Central ID:
  PMC10154857
• Document Type:
  Journal Article
• Funding:
  I01 BX004619/BX/BLRD VAUnited States/ ; IK2 CX001779/CX/CSRD VAUnited States/ ; T42 OH008429/OH/NIOSH CDC HHSUnited States/ ; UH3 HL152323/HL/NHLBI NIH HHSUnited States/
• Volume:
  163
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:2a9c0341bea0e9a42e46b9fa6f8f2dff46bfda3b3a3ab03ac3878ac398448201
• Download URL:
  https://stacks.cdc.gov/view/cdc/138301/cdc_138301_DS1.pdf
• File Type:
  [PDF - 1010.63 KB ]