Quality of Spirometry Tests in Periodic Examination of Workers
Spirometry is a tool for screening and early diagnosis of harms caused by occupational respiratory exposures. Since spirometry results largely depend on the spirometry method, their credibility and acceptability may vary. Accordingly, this cross-sectional study was conducted to assess the quality of spirometry procedures and reports in the periodic examinations of workers in an industry. The study assessed a total number of 506 recorded spirometry test results related to the periodic examinations of 190 workers in an industry between 2005 and 2015. Each test was assessed in terms of ATS (American Thoracic Society) standards and the quality of reporting, and the obtained results were compared with the spirometry tests conducted by the research team. The most common error in performing these tests was the failure to allow for the 6-second exhalation (in 70% of the cases). After removing the effect of increasing age, it was found that the reported FVC (Forced Vital Capacity) and FEV1 (Forced Expiratory Volume in one second ) in these tests were different from those in the standard spirometry tests performed by the research team by 5% in more than half of the cases and by more than 10% in a quarter of the cases. The results revealed the poor quality of the spirometry tests in the periodic examinations of the workers. Therefore, it is recommended to train the spirometry operators and monitor more vigorously the quality of spirometry tests in the occupational examinations.
National Research Council (U.S.). Committee to Review the Respiratory Diseases Research Program. Board on Environmental Studies and Toxicology., National Research Council (U.S.). Board on Environmental Studies and Toxicology. Respiratory diseases research at NIOSH : reviews of research programs of the National Institute for Occupational Safety and Health. Washington, D.C.: National Academies Press; 2008. xviii, 231 p. p.
Tarlo S, Cullinan P, Nemery B. Occupational and environmental lung diseases : diseases from work, home, outdoor and other exposures. Hoboken, NJ: Wiley; 2010. xx, 468 p. p.
Fishwick D, Naylor S. COPD and the workplace. Is it really possible to detect early cases? Occup Med (Lond). 2007;57(2):82-4.
Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26(2):319-38.
Sircar K, Hnizdo E, Petsonk E, Attfield M. Decline in lung function and mortality: implications for medical monitoring. Occup Environ Med. 2007;64(7):461-6.
Young RP, Hopkins R, Eaton TE. Forced expiratory volume in one second: not just a lung function test but a marker of premature death from all causes. Eur Respir J. 2007;30(4):616-22.
Townsend MC. Evaluating pulmonary function change over time in the occupational setting. J Occup Environ Med. 2005;47(12):1307-16.
Hankinson JL, Wagner GR. Medical screening using periodic spirometry for detection of chronic lung disease. Occup Med. 1993;8(2):353-61.
Lung-Function Testing - Selection of Reference Values and Interpretative Strategies. American Review of Respiratory Disease. 1991;144(5):1202-18.
Enright PL. How to make sure your spirometry tests are of good quality. Respir Care. 2003;48(8):773-6.
Wanger J, Clausen JL, Coates A, Pedersen OF, Brusasco V, Burgos F, et al. Standardisation of the measurement of lung volumes. Eur Respir J. 2005;26(3):511-22.
Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005;26(5):948-68.
Hankinson JL, Odencrantz JR, Fedan KB. Spirometric reference values from a sample of the general U.S. population. Am J Respir Crit Care Med. 1999;159(1):179-87.
Kuziemski K, Slominski W, Specjalski K, Jassem E, Kalicka R, Slominski JM. [Accuracy of spirometry performed by general practitioners and pulmonologists in Pomeranian Region in the "Prevention of COPD" NHS program]. Pneumonologia i alergologia polska. 2009;77(4):380-6.
Valenti E, Manzari G, De Angelis V, Ercolani S, Liberati A, Capitta C, et al. [Quality control of spirometric tests used in health surveillance for occupational exposure risk, in the province of Viterbo]. Med Lav. 2001;92(1):5-11.
Seyedmehdi SM, Attarchi M, Yazdanparast T, Lakeh MM. Quality of spirometry tests and pulmonary function changes among industrial company workers in Iran: a two-year before-and-after study following an intensive training intervention. Prim Care Respir J. 2013;22(1):86-91.
Eaton T, Withy S, Garrett JE, Mercer J, Whitlock RML, Rea HH. Spirometry in primary care practice*: The importance of quality assurance and the impact of spirometry workshops. Chest. 1999;116(2):416-23.
Leuppi JD, Miedinger D, Chhajed PN, Buess C, Schafroth S, Bucher HC, et al. Quality of spirometry in primary care for case finding of airway obstruction in smokers. Respiration; international review of thoracic diseases. 2010;79(6):469-74.
Enright P, Vollmer WM, Lamprecht B, Jensen R, Jithoo A, Tan W, et al. Quality of spirometry tests performed by 9893 adults in 14 countries: the BOLD Study. Respir Med. 2011;105(10):1507-15.
Tan WC, Bourbeau J, O'Donnell D, Aaron S, Maltais F, Marciniuk D, et al. Quality assurance of spirometry in a population-based study -predictors of good outcome in spirometry testing. Copd. 2014;11(2):143-51.
Akhtar R, Wilson A. A comparison of spirometry in general practice and a pulmonary function laboratory. Prim Care Respir J. 2005;14(4):215-20.
Enright PL, Johnson LR, Connett JE, Voelker H, Buist AS. Spirometry in the Lung Health Study. 1. Methods and quality control. Am Rev Respir Dis. 1991;143(6):1215-23.
Nowinski A, Romanski E, Bielen P, Bednarek M, Puscinska E, Goljan-Geremek A, et al. Pilot program on distance training in spirometry testing - the technology feasibility study. Pneumonologia i alergologia polska. 2015;83(6):431-5.