Chest
Diffuse Lung Disease: Original ResearchA Systematically Derived Exposure Assessment Instrument for Chronic Hypersensitivity Pneumonitis
Section snippets
Identification of the Delphi Items
Potential exposure items for inclusion in an assessment instrument were identified through a systematic review of the literature. Electronic searches were performed though Medline, EMBASE, and the Cochrane Register of Controlled Trials from January 1, 1990, to April 30, 2019, using the following terms: “chronic hypersensitivity pneumonitis,” “fibrotic hypersensitivity pneumonitis,” “hypersensitivity pneumoni∗,” and “extrinsic allergic alveolitis.” Two reviewers (H.B., and J.L.) screened all
Systematic Literature Review
The systematic literature search yielded 38,001 citations; after screening, 922 citations were included in the final analysis (Fig 1). The most common reasons for exclusion included not involving HP patients, no exposure assessment performed or reported, and no cases presented (review or editorial). The review identified 60 unique exposures, of which 24 had more than five citations, and these were presented in the Delphi survey. An additional five exposure items were identified by experts and
Discussion
Through a systematic literature review, Delphi consensus of ILD experts, and patient validation process, we have developed an exposure assessment instrument for CHP containing a short, meaningful, and manageable list of exposures. This represents a systematic and methodologically robust approach to developing such an instrument, including theorization of a conceptual network and item development, adjustment of the conceptual network, authentication of the framework/pretesting and refinement of
Conclusion
This Delphi survey provides items that ILD experts agree are important to ask in all patients presenting with suspected CHP and provides a basis for a systematically derived CHP exposure assessment instrument. Ongoing research is required to validate these items in the clinical setting.
Acknowledgments
Author contributions: H. B. led the project, ethics adherence, data analysis, and manuscript preparation. All authors contributed to the concept and design of the project, data interpretation, manuscript synthesis, and revisions. H. B. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Financial/nonfinancial disclosures: The authors have reported to CHEST the following: P. M. has, via his institution,
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2021, Respiratory MedicineCitation Excerpt :Identifying an environmental and/or occupational exposure known to be associated with HP is an important part of the diagnostic evaluation, and guides disease management. However, exposure identification can be challenging given the long list of potentially causative exposures, plus the lack of a gold standard method for identifying HP-associated exposures [2,3]. International consensus diagnostic guidelines for HP were recently published, with strong emphasis on exposure identification to guide diagnostic confidence [1].
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2021, ChestCitation Excerpt :Recently, there has been progress in developing a questionnaire to determine significant exposures in fibrotic HP.41 Through review of the literature, a list of inciting exposures was created; it was then narrowed to key items by using the Delphi method to develop a questionnaire, which was then tested for timing and clarity in a small sample of patients.41 The questionnaire has not yet been validated against a gold standard.
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FUNDING/SUPPORT: This work was supported by a National Health and Medical Research Council PhD Postgraduate Scholarship and National Institutes of Health, National Heart, Lung, and Blood Institute [Grant K24HL127131].
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Collaborators from the CHP Exposure Assessment are listed in the Acknowledgments.