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

Details

• Personal Author:
  Amorosa JK ; Arjomandi M ; Blanc PD ; D'Armiento JM ; Falvo MJ ; Franks TJ ; Galvin JR ; Garshick E ; Hines SE ; Jones KD ; Kazerooni EA ; Krefft SD ; Kreiss, Kathleen ; Miller RF ; Morris MJ ; Osterholzer JJ ; Polosukhin VV ; Robertson MW ; Rose CS ; Sotolongo AM
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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. Description provided by NIOSH
• Subjects:
  • Diagnosis
  • Environmental Exposure
  • Lung Diseases
  • Occupational Health
  • Respiratory System
  • Respiratory Tract Diseases
  • Safety
• Keywords:
  • Respiratory diseases
  • Military personnel
  • Bronchiolitis
  • Diagnostic tests
  • Clinical diagnosis
  • Environmental exposure
  • Lung disease
  • Author Keywords: bronchiolitis
  • Delphi technique
  • dyspnea
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• ISSN:
  0012-3692
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  California ; Colorado ; Maryland ; Massachusetts ; Michigan ; New Jersey ; New York ; OSHA Region 1 ; OSHA Region 2 ; OSHA Region 3 ; OSHA Region 4 ; OSHA Region 5 ; OSHA Region 6 ; OSHA Region 8 ; OSHA Region 9 ; Tennessee ; Texas ; West Virginia
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• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  RHD - Respiratory Health Division
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  163
• Issue:
  3
• NIOSHTIC Number:
  nn:20067149
• Citation:
  Chest 2023 Mar; 163(3):599-609
• Contact Point Address:
  Michael J. Falvo PhD, Airborne Hazards and Burn Pits Center of Excellence, Department of Veterans Affairs New Jersey Health Care System, East Orange, NJ
• Email:
  Michael.Falvo@va.gov
• Federal Fiscal Year:
  2023
• Performing Organization:
  University of California, Berkeley
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  Chest
• End Date:
  20250630
• Download URL:
  https://stacks.cdc.gov/view/cdc/231302/cdc_231302_DS1.pdf
• File Type:
  [PDF - 777.76 KB]
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:bbbee3960427e2b1c589d3b1f3f7bae663ee3bca6cbe99967fa37d2993cb814874da184fdb8bc61e981ae81a50f1914eea209fddb0f2e1aabefdb6f75b78ec4e