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

Michael J Falvo1, Anays M Sotolongo1, John J Osterholzer2

  • 1Airborne Hazards and Burn Pits Center of Excellence, Department of Veterans Affairs New Jersey Health Care System, East Orange, NJ; New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, NJ.

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|November 7, 2022
PubMed
Summary

Diagnosing constrictive bronchiolitis (CB) in deployed individuals is challenging. This study established consensus on diagnostic criteria and introduced deployment-related respiratory disease (DRRD) as a broader term for postdeployment respiratory conditions.

Keywords:
Delphi techniquebronchiolitisdyspneaenvironmental exposuremilitary deployment

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Area of Science:

  • Pulmonary Medicine
  • Military Health
  • Diagnostic Criteria Development

Background:

  • Diagnosing constrictive bronchiolitis (CB) in previously deployed individuals presents challenges due to inconsistent histopathologic criteria and clinical assessments.
  • Respiratory symptoms in this population require standardized evaluation and terminology.

Purpose of the Study:

  • To establish consensus-based recommendations for the diagnostic workup of respiratory symptoms in previously deployed individuals.
  • To define appropriate terminology for deployment-related respiratory conditions.
  • To address the diagnostic challenges associated with constrictive bronchiolitis (CB) in this cohort.

Main Methods:

  • A modified Delphi study involving 19 experts was conducted over three rounds.
  • Experts ranked their agreement on statements regarding diagnostic criteria and approaches.
  • Rank-order voting was used to determine the recommended diagnostic approach and terminology.

Main Results:

  • Consensus was reached on 25 out of 28 statements.
  • Constrictive bronchiolitis (CB) was defined as a histologic pattern of lung injury in previously deployed individuals, emphasizing consideration of alternative diagnoses.
  • A diagnostic approach was established, differentiating local and specialty referral center assessments.
  • Deployment-related respiratory disease (DRRD) was proposed as an umbrella term for various postdeployment respiratory findings.

Conclusions:

  • Consensus statements provide a structured clinical approach for evaluating potential constrictive bronchiolitis (CB) in previously deployed individuals.
  • The term deployment-related respiratory disease (DRRD) offers a broad descriptor for diverse postdeployment respiratory conditions.
  • Further research on DRRD progression and natural history is essential for refining clinical understanding and nosology.