Idiopathic Constrictive Bronchiolitis in an Active Duty Soldier.

Constrictive bronchiolitis is characterized by fibroproliferative thickening of the bronchiolar walls causing narrowing of the bronchiolar lumen, which may progress to the complete obliteration of bronchioles, resulting in progressive dyspnea and ultimately respiratory failure. Active duty service members returning from deployment with toxic exposures such as "burn pits" are known to be at risk for this condition. Other proposed etiologies for this condition include inhalation (nitrogen oxides, ammonia, welding fumes, aerosols [nicotine, diacetyl, and vitamin E acetate]), infection (respiratory syncytial virus, adenovirus, or Mycoplasma pneumoniae), rheumatic diseases, and graft-versus-host disease (lung or hematopoietic cell transplantation). Uncommonly, constrictive bronchiolitis can also be idiopathic. Here we present a case of a young active duty soldier with idiopathic constrictive bronchiolitis without any known risk factors for this disease. The goal of this case presentation is to help the military physician better understand this condition, including identification of this disease process, underlying etiologies, risk factors, and treatments available.

Leveraging Tele-Critical Care Capabilities for Clinical Trial Consent.

A severe coronavirus disease 2019 patient admitted to our institution for medical management was enrolled in a randomized placebo-controlled trial of an investigational therapeutic for coronavirus disease 2019. We leveraged existing video-telecommunication equipment to obtain informed consent. We found video-telecommunication use closely mirrored person-to-person contact for research consent by maintaining engagement and ensuring understanding. Video-telecommunication use facilitated clinical research while minimizing unnecessary exposure to coronavirus disease 2019 and conserving personal protective equipment. Prior to the coronavirus disease 2019 pandemic, research regulatory agencies were essentially silent on the matter of video-telecommunication consent. Regulatory guidance became available during the pandemic in response to increased isolation and social distancing practices. Virtual health and telemedicine use expanded greatly during the pandemic, and this increase will likely persist after the pandemic ends. We anticipate video-telecommunication adoption and implementation for research consent will also continue to grow after the coronavirus disease 2019 pandemic is over.