1. Consensus Statements on Deployment-Related Respiratory Disease, Inclusive of Constrictive Bronchiolitis: A Modified Delphi Study.
- Author
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Falvo, Michael, Sotolongo, Anays, Osterholzer, John, Robertson, Michelle, Kazerooni, Ella, Amorosa, Judith, Garshick, Eric, Jones, Kirk, Galvin, Jeffrey, Kreiss, Kathleen, Hines, Stella, Franks, Teri, Miller, Robert, Rose, Cecile, Arjomandi, Mehrdad, Krefft, Silpa, Morris, Michael, Polosukhin, Vasiliy, Blanc, Paul, and DArmiento, Jeanine
- Subjects
Delphi technique ,bronchiolitis ,dyspnea ,environmental exposure ,military deployment ,Humans ,Lung Injury ,Delphi Technique ,Respiratory Tract Diseases ,Bronchiolitis Obliterans ,Respiration Disorders - Abstract
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.
- Published
- 2023