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
• 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:
  Author Keywords: Bronchiolitis Bronchiolitis Clinical Diagnosis Delphi Technique Diagnostic Tests Dyspnea Environmental Exposure Lung Disease Military Deployment Military Personnel Respiratory Diseases

  More +
• 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
• 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
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:bbbee3960427e2b1c589d3b1f3f7bae663ee3bca6cbe99967fa37d2993cb814874da184fdb8bc61e981ae81a50f1914eea209fddb0f2e1aabefdb6f75b78ec4e
• Download URL:
  https://stacks.cdc.gov/view/cdc/231302/cdc_231302_DS1.pdf
• File Type:
  [PDF - 777.76 KB ]