Disc lo sure o f F ina nc ia l I nte re st F unde d b y the - PDF document

What lung func tion study should I or der and why? Unive r sity of Califor nia, San F r anc isc o – Division of OE M Mar c h 5, 2020 R obe r t Cohe n, MD, F CCP Clinic a l Pro fe sso r - E OHS, Unive rsity o f Illino is Sc ho o l o f Pub lic He a lth Chic a g o , Illino is Pro fe sso r o f Me dic ine No rthwe ste rn Unive rsity F e inb e rg Sc ho o l o f Me dic ine Ca rdio pulmo na ry E xe rc ise T e sting the Chic a g o Bla c kha wks Pre -Se a so n 2009 Disc lo sure o f F ina nc ia l I nte re st  F unde d b y the Alpha F o unda tio n fo r the I mpro ve me nt o f Mine Sa fe ty a nd He a lth  F unde d b y HHS/ HRSA/ ORHP/ BL CP & BL CE  E mplo ye e o f NI OSH/ RHD  F unde d b y USDOL / OWCP & MSHA  F unde d b y Que e nsla nd Go ve rnme nt, Austra lia  Pro vide I ME ’ s fo r Oc c upa tio na l L ung Dise a se Go a l fo r T o da y’ s T a lk  Disc uss the indic a tio ns fo r lung func tio n te sting in o c c upa tio na l me dic ine  Disc uss the whic h te sts sho uld use d, a nd the ir stre ng ths a nd limita tio ns

I ndic a tio ns fo r lung func tio n te sting in o c c upa tio na l me dic ine  Pre -e mplo yme nt  Me dic a l Sc re e ning a nd Surve illa nc e  Dia g no sis o f spe c ific o c c upa tio na l lung dise a se  Re turn to wo rk  Disa b ility E va lua tio n Co mmo nly Use d Pulmo na ry F unc tio n T e sts  Spiro me try  L ung Vo lume Me a sure me nts  Diffusing Ca pa c ity  Arte ria l Blo o d Ga se s  Airwa y Re sista nc e , I mpulse Osc illo me try  L ung Me c ha nic s MI P, ME P, PV Curve s  Airwa y Re a c tivity/ Cha lle ng e  Ca rdio pulmo na ry e xe rc ise te sting I ndic a tio ns fo r Pre -E mplo yme nt Spiro me try  I ndustrie s whic h re q uire c a pa b ility to pe rfo rm he a vy e xe rtio n  F ire fig hte rs, Po lic e , Milita ry  I ndustrie s with e xpo sure to re spira to ry ha za rds  I ndustrie s whic h re q uire a re spira to ry pro te c tio n pro g ra m (ma y a pply o nly to a sub se t o f wo rke rs de pe nding o n re spo nse to re spira to ry q ue stio nna ire ).

I ndic a tio ns fo r Me dic a l Sc re e ning a nd Surve illa nc e - Spiro me try  Asb e sto s  Be nze ne – e ve ry 3 ye a rs if re spira to r re q uire d  Ca dmium  Co a l mine rs o n hire – vo lunta ry e ve ry 5 ye a rs  Co ke Ove n E missio ns I ndic a tio ns fo r Me dic a l Sc re e ning a nd Surve illa nc e - Spiro me try  Co tto n Dust  F o rma lde hyde – if re sp pro te c tio n is use d  Silic a e xpo se d wo rke rs a s o f 2016 ne w OSHA Silic a sta nda rd.  > 25 ug / m3 fo r a t le a st 6 mo nths  HAZWOPE R  (Ha za rd o us Wa ste Ope ra tio ns a nd E me rg e nc y Re spo nse )

Optima l Co nditio ns F o r PF T s  E xc e lle nt e q uipme nt we ll c a lib ra te d  Pa tie nt a nd te c h spe a k sa me la ng ua g e , ha ve g o o d ra ppo rt, a nd a re b o th hig hly mo tiva te d  Pre vio us study b e fo re pa tie nt wa s e xpo se d o r b e c a me ill fo r c o mpa riso n  Appro pria te re fe re nc e va lue s L imita tio ns o f Pulmo na ry F unc tio n T e sts  Me a sure me nts a re Hig hly Va ria b le  Bio lo g ic / individua l va ria b ility  Me a sure me nt va ria b ility  T e mpo ra l va ria b ility Critic a l e le me nts o f a spiro me try pro g ra m

40 yo , Cauc asian , male , pr e -e mployme nt physic al Spiro me te r Ac c ura c y Pe rfo rma nc e AT S 2019 Sta te me nt – Gra ha m e t. a l. 2019  Upda te s the 2005 AT S/ E RS Sta te me nt  Instrume nts must me e t ne w ISO 26782:2009 Sta nda rds  Ma ximum pe rmissib le a c c ura c y e rro r o f ± 2.5%  Ope ra to r tra ining a nd c o mpe te nc y sta nd a rd s  Ro le o f inspira to ry ma ne uve rs – c o ntro ve rsia l fo r Oc c Me d  (T o wnse nd – AJRCCM 2020)  Ac c e pta b ility a nd re pe a ta b ility a nd E OF E upd a te d  Ind e pe nd e nt la b o ra to ry va lid a tio n te sting fo r pro to type spiro me te rs a nd so ftwa re  NIOSH Re c o mme nd s c e rta in spiro me te rs https:/ / www.c d c .g o v/ nio sh/ to pic s/ c whsp/ ma nuf_ta b le 06-04-18.html

NI OSH-Appro ve d Spiro me try T ra ining Pro g ra m  Cre a te d b y 1978 OSHA Co tto n Dust Sta nda rd  NI OSH a dministe rs pro g ra m  Spo nso rs te a c h c o urse  E ndo rse d a s a mo de l tra ining pro g ra m b y  AT S  ACOE M Co urse De sig n  Minimum o f 16 ho urs:  8 ho urs o f ha nds o n use o f e q uipme nt  E q uipme nt c a lib ra tio n c he c ks  E mplo ye e instruc tio n a nd te sting  Ide ntifying a nd c o rre c ting te st pro b le ms  4 ho urs o f le c ture s (the o ry a nd te sting pro c e dure s)  2 ho urs o f sta nda rdize d te sting  Writte n e xa mina tio n  Pra c tic a l e xa mina tio n NI OSH Re so urc e s http:/ / www.c dc .gov/ niosh/ doc s/ 2004-154c /

Pre dic tio n E q ua tio ns 19 1. Glo b a l L ung Initia tive 2012 – re c o mme nde d b y ne w AT S/ E RS sta nda rd 2019 2. Na tio na l He a lth a nd Nutritio n E xa mina tio n Surve y* (NHANE S II I ) – Ha nkinso n 1999  Re c o mme nde d by OS HA (2013), ACOE M (2011), AT S / E RS (2005) 2. K nudso n 1983 – Bla c k L ung Disa b ility USDOL 3. K nudso n 1976 – (OSHA Co tto n Dust Sta nda rd) 4. Cra po 1981 - (AMA g uide s) Glo b a l L ung I nitia tive  Spiro me try 2012 a nd DL CO 2017  E thnic ity  White (E uro pe a n a nc e stry)  Afric a n Ame ric a n  No rthe a st Asia n  So uthe a st Asia n  Othe r/ Mixe d Re fe re nc e E q ua tio ns NHANE S I I I – fo r Oc c upa tio na l Me dic ine  Re fe re nc e E q ua tio ns – NHANE S II I – Ha nkinso n 1999  White (E uro pe a n a nc e stry)  Afric a n Ame ric a n  Me xic a n Ame ric a n  Othe r – ma y use c o rre c tio n fa c to rs

 Pa tie nt Pre p - re mo ve de nture s - OK  No se c lip in pla c e – e xc e pt fo r e xpira to ry lo o ps o nly  Re a ltime displa y with dig ita l fe e db a c k to pa tie nts during fo rc e d e xpira tio n impro ve s pa tie nt e xpe rie nc e a nd E OF E  Displa y vo lume time a nd flo w vo lume fo r QA  Sa fe ty o f spiro me try - 5/ 10,000 e piso de s in te rtia ry c a re ho spita l – a ll we re sync o pe Re la tive c o ntra indic a tio ns to spiro me try Re la tive c o ntra indic a tio ns to spiro me try

Re la tive c o ntra indic a tio ns to spiro me try Pe rfo rma nc e o f F VC Ma ne uve r  Cha ng e s fro m 2005 Sta te me nt  Ra pid inha le to T L C – he sita tio n < 2 se c  E OF E 15 se c o nds o r pla te a u, < 25 ml in la st se c o nd  No minimum F E T b ut must ha ve re pe a ta b le F VC  F IVC-F VC must b e le ss tha n 0.1 lite r o r < 5% o f F VC whic he ve r is g re a te r  F IVC is impo rta nt c he c k o n ma xima l inspira tio n prio r to F VC  Ba c k E xtra po la te d Vo lume (BE V) e rro r is no w 0.100 lite r no t 0.15 a nd still <5% F VC whic he ve r is g re a te r Pe rfo rma nc e o f F VC Ma ne uve r  F VC Ma ne uve r – re pe a ta b ility  0.15 ML > 6  0.1 ml 6 o r yo ung e r o r 10% o f la rg e st F VC  8 ma ne uve rs  Bro nc ho d ila to r re spo nsive ne ss – te ste d e ve n with no rma l pre -b ro nc ho dila to r te sting – fo r dia g no stic studie s  Cha ng e in b ro nc ho d ila to r a s c ha ng e in % re fe re nc e no t % c ha ng e

T e st Re po rt – Minimum Gra phic Size s Also re q uire s re a l time g ra phic s T o wnse nd, MC e t. a l. JOE M. 2011;53:569-584 AT S/ E RS Spiro me te r Pe rfo rma nc e - sta nda rdize d e le c tro nic o utput  Co mple te te st re sults a re sa ve d  F ull da ta fro m flo w vo lume lo o ps re ta ine d  T ra c ing s c a n b e re c o nstruc te d a t a la te r da te , if ne e de d

ACOE M – De dic a te d c a lib ra tio n c he c k ro utine Ove rsig ht b y E xpe rie nc e d Pe rso nne l  Re vie we r sho uld b e kno wle dg e a b le a b o ut spiro me try a c c ura c y a nd te st va lidity  F e e db a c k me c ha nism a nd fre q ue nc y  Pe rfo rma nc e a c c o unta b ility Upda te T ra ining a nd F e e db a c k I mpro ve T e st Qua lity

I nte rpre ta tio n o f Re sults  Co mpa ring re sults to re fe re nc e va lue s  L o ng itudina l a sse ssme nt L o ng itudina l I nte rpre ta tio n  ACOE M a nd AT S a do pte d the 15% de c line in %re fe re nc e fro m b a se line a s a re c o mme nde d “lo ng itudina l no rma l limit” (a llo ws fo r a ve ra g e lo ss due to no rma l a g ing ) L o ng itudina l I nte rpre ta tio n  I n 2003, NI OSH de ve lo pe d “Spiro me try L o ng itudina l Da ta Ana lysis (SPI ROL A)” so ftwa re to o l to a ssist with inte rpre ta tio n o f lo ng itudina l spiro me try da ta (c re a te s “lo ng itudina l limit o f de c line ” b a se d o n da ta pre c isio n)