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

Michael J. Falvo*, Anays M. Sotolongo, John J. Osterholzer, Michelle W. Robertson, Ella A. Kazerooni, Judith K. Amorosa, Eric Garshick, Kirk D. Jones, Jeffrey R. Galvin, Kathleen Kreiss, Stella E. Hines, Teri J. Franks, Robert F. Miller, Cecile S. Rose, Mehrdad Arjomandi, Silpa D. Krefft, Michael J. Morris, Vasiliy V. Polosukhin, Paul D. Blanc, Jeanine M. D'Armiento

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

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.

Original languageEnglish
Pages (from-to)599-609
Number of pages11
JournalChest
Volume163
Issue number3
DOIs
StatePublished - Mar 2023

Keywords

  • bronchiolitis
  • Delphi technique
  • dyspnea
  • environmental exposure
  • military deployment

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