Scoping review of exposure questionnaires and surveys in interstitial lung disease

Our plain-English summary of Scoping review of exposure questionnaires and surveys in interstitial lung disease, by H. Barnes, S. Elmrayed, C.M. Barber, et al (BMJ Open Respiratory Research, 2024).

The study

• Authors: H. Barnes, S. Elmrayed, C.M. Barber, J. Feary, C.T. Lee, S. Gandhi, C.E. Peters, M.L. Salisbury, K.A. Johannson
• Journal: BMJ Open Respiratory Research
• Published: 2024;11(1)
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Many interstitial lung diseases (ILDs) have clear causal relationships with environmental and occupational exposures. Exposure identification can assist with diagnosis, understanding disease pathogenesis, prognostication and prevention of disease progression and occurrence in others at risk. Despite the importance of exposure identification in ILD, there is no standardised assessment approach. Many questionnaires are in clinical and research use, yet their utility, applicability, relevance and performance characteristics are unknown.

Objectives: This scoping review aimed to summarise the available evidence relating to ILD exposure assessment questionnaires, identify research gaps and inform the content for a future single evidence-based ILD questionnaire.

Methods: A scoping review based on Arksey and O'Malley's methodological framework was conducted.

Eligibility Criteria: Any questionnaire that elicited exposures specific to ILD was included. A modified COSMIN Risk of Bias Framework was used to assess quality.

Sources Of Evidence: Relevant articles were identified from MEDLINE and EMBASE up to 23 July 2023.

Results: 22 exposure questionnaires were identified, including 15 generally pertaining to ILD, along with several disease-specific questionnaires for hypersensitivity pneumonitis (n=4), chronic beryllium disease, sarcoidosis and silicosis (1 questionnaire each). For most questionnaires, quality was low, whereby the methods used to determine exposure inclusion and questionnaire validation were not reported or not performed. Collectively the questionnaires covered 158 unique exposures and at-risk occupations, most commonly birds, mould/water damage, wood dust, asbestos, farming, automotive mechanic and miners. Only five questionnaires also provided free-text fields, and 13 queried qualifiers such as temporality or respiratory protection.

Conclusions: Designing a robust ILD-specific questionnaire should include an evidence-based and relevance-based approach to exposure derivation, with clinicians and patients involved in its development and tested to ensure relevance and feasibility.

© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

In plain English

This was a scoping review of questionnaires, not a study of patients. The authors searched MEDLINE and EMBASE from their start up to 23 July 2023, along with Google, and contacted lung disease registries. They looked for questionnaires used to find environmental and work exposures in interstitial lung disease (ILD), a group of disorders that inflame or scar the lung and includes asbestosis. From 4936 records they found 22 questionnaires. Together these covered 158 specific exposures. The most often included were birds (16 questionnaires); mould/water damage, wood and farming (14 each); and asbestos and metal fumes or metal working fluids (11 each). Among job settings, automotive mechanics appeared in 11 and miners in 10. Only five questionnaires had a free-text field, 13 tried to measure dose or duration, and only two asked about respiratory protection. The authors judged most questionnaires at high risk of bias, mainly because development methods were not reported. They noted that asking only about the past 3 years would miss long-latency exposures such as asbestos. The authors concluded that current questionnaires have gaps in development and validation.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Scoping review of published and grey-literature ILD exposure questionnaires, with quality assessed using an adapted COSMIN Risk of Bias tool
• Who was studied: 22 unique exposure questionnaires for interstitial lung disease, identified from 4936 records in MEDLINE, EMBASE, Google and ILD registries, up to 23 July 2023
• Exposure: Environmental and occupational exposures listed in the questionnaires, including birds, mould/water damage, wood, farming, asbestos and metal fumes or metal working fluids
• Main results:
  • Across the 22 questionnaires, 158 specific exposures were covered
  • Of 48 occupational settings, the most frequently included were farm work (14 questionnaires), paper mill workers (13), automotive mechanics (11) and miners (10)
  • Only five questionnaires provided a free-text field for additional exposures
  • 13 questionnaires attempted to qualify dose or duration of exposure
  • Only two questionnaires asked about use of respiratory protection
  • Most questionnaires were judged at high risk of bias, mainly because development methods were not reported
  • Only one questionnaire reported validation among patients
  • The authors noted that questionnaires asking only about the previous 3 years would be insufficient for long-latency exposures such as asbestos
• The authors' conclusion: The authors concluded that several ILD exposure questionnaires exist but have gaps in development and validation, and that a future questionnaire should be evidence-based and developed with clinicians and patients
• Limitations the authors state:
  • Relevant questionnaires may have been missed, particularly in the grey literature
  • Methods of derivation may have been missed if not sufficiently reported
  • The quality assessment method was chosen arbitrarily and others may not consider it applicable
  • Some review authors were also authors of included questionnaires

Topics

Medical terms in this study, explained in our Lexicon: Interstitial Lung Disease, Occupational Exposure, Disease Progression, Pneumonitis, Silicosis, Respirator.

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