Consensus Statements on Deployment-Related Respiratory Disease, Inclusive of Constrictive Bronchiolitis: A Modified Delphi Study.
Delphi technique
bronchiolitis
dyspnea
environmental exposure
military deployment
Journal
Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335
Informations de publication
Date de publication:
03 2023
03 2023
Historique:
received:
01
07
2022
revised:
10
10
2022
accepted:
26
10
2022
pubmed:
8
11
2022
medline:
14
3
2023
entrez:
7
11
2022
Statut:
ppublish
Résumé
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. What are the recommended diagnostic workup and associated terminology of respiratory symptoms in previously deployed individuals? 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 36343686
pii: S0012-3692(22)04047-8
doi: 10.1016/j.chest.2022.10.031
pmc: PMC10154857
pii:
doi:
Types de publication
Practice Guideline
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, Non-U.S. Gov't
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
599-609Subventions
Organisme : CSRD VA
ID : IK2 CX001779
Pays : United States
Organisme : NIOSH CDC HHS
ID : T42 OH008429
Pays : United States
Organisme : NHLBI NIH HHS
ID : UH3 HL152323
Pays : United States
Informations de copyright
Published by Elsevier Inc.
Références
F1000 Med Rep. 2010 Apr 27;2:
pubmed: 20948853
N Engl J Med. 2011 Jul 21;365(3):222-30
pubmed: 21774710
JAMA. 2018 Sep 11;320(10):1074
pubmed: 30208457
Semin Respir Crit Care Med. 2015 Jun;36(3):366-78
pubmed: 26024345
Radiographics. 2015 Sep-Oct;35(5):1360-80
pubmed: 26274445
Am J Surg Pathol. 2021 Dec 1;45(12):1587-1596
pubmed: 34081035
Chest. 2013 May;143(5):1436-1443
pubmed: 23648907
J Occup Environ Med. 2012 Jan;54(1):1-2
pubmed: 22227868
J Clin Epidemiol. 2014 Apr;67(4):401-9
pubmed: 24581294
Ther Adv Respir Dis. 2013 Aug;7(4):235-45
pubmed: 23470637
Radiology. 2022 Jul;304(1):185-192
pubmed: 35289657
Curr Opin Pulm Med. 2015 Mar;21(2):185-92
pubmed: 25575366
J Occup Environ Med. 2012 Jun;54(6):746-51
pubmed: 22588477
J Occup Environ Med. 2020 May;62(5):337-343
pubmed: 31977922
Palliat Med. 2017 Sep;31(8):684-706
pubmed: 28190381
N Engl J Med. 2022 Apr 7;386(14):1352-1357
pubmed: 35388671
BMC Pulm Med. 2022 Apr 27;22(1):163
pubmed: 35477425
J Thorac Imaging. 2022 Mar 1;37(2):117-124
pubmed: 34121086
Am J Respir Crit Care Med. 2022 Sep 15;206(6):786-789
pubmed: 35608541
N Engl J Med. 2011 Oct 27;365(17):1567-75
pubmed: 22029978
Mil Med. 2020 Dec 30;185(11-12):472-475
pubmed: 32761145
Chest. 2020 Jun;157(6):1559-1567
pubmed: 32017933
Ann Am Thorac Soc. 2019 Aug;16(8):e1-e16
pubmed: 31368802
Lung. 2021 Aug;199(4):345-355
pubmed: 34363506
J Occup Environ Med. 2011 Sep;53(9):961-5
pubmed: 21866049
Ann Am Thorac Soc. 2018 Dec;15(12):1411-1419
pubmed: 30339479
Mil Med. 2002 Apr;167(4):281-8
pubmed: 11977877
Hum Pathol. 2022 Jun;124:56-66
pubmed: 35240130