Dorsett D. Smith

Spirometry in the Occupational Setting

: This position statement reviews several aspects of spirometric testing in the workplace, where spirometry is employed in the primary, secondary, and tertiary prevention of occupational lung disease. Primary prevention includes pre-placement and fitness-for-duty examinations as well as research and monitoring of health status in groups of exposed workers; secondary prevention includes periodic medical screening of individual workers for early effects of exposure to known occupational hazards; and tertiary prevention includes clinical evaluation and impairment/disability assessment. For all of these purposes, valid spirometry measurements are critical, requiring: documented spirometer accuracy and precision, a rigorous and standardized testing technique, standardized measurement of pulmonary function values from the spirogram, adequate initial and refresher training of spirometry technicians, and, ideally, quality assessment of samples of spirograms. Interpretation of spirometric results usually includes comparison with predicted values and should also evaluate changes in lung function over time. Response to inhaled bronchodilators and changes in relation to workplace exposure may also be assessed. Each of these interpretations should begin with an assessment of test quality and, based on the most recent ATS recommendations, should rely on a few reproducible indices of pulmonary function (FEV1, FVC, and FEV1/FVC.) The use of FEF rates (e.g., the FEF25-75%) in interpreting results for individuals is strongly discouraged except when confirming borderline airways obstruction. Finally, the use of serial PEF measurements is emerging as a method for confirming associations between reduced or variable pulmonary function and workplace exposures in the diagnosis of occupational asthma. Throughout this position statement, ACOEM makes detailed recommendations to ensure that each of these areas of test performance and interpretation follow current recommendations/standards in the pulmonary and regulatory fields. Submitted by the Occupational and Environmental Lung Disorder Committee on November 16,1999. Approved by the ACOEM Board of Directors on January 4,2000.

Top Ten List in Occupational Pulmonary Disease

This is a consensus statement by a committee that included experts in allergy and clinical immunology, building engineering, environmental health, epidemiology, exposure assessment, microbiology, public health, and toxicology. The Institute of Medicine conducted a comprehensive review of the scientific literature regarding the relationship between damp or moldy indoor environments and the manifestation of adverse health effects, particularly respiratory and allergic symptoms. The review focused on the noninfectious health effects of fungi, including allergens, mycotoxins, and other biologically active products. Chapters include a multidisciplinary review of the literature on building issues related to wetness, mycology, epidemiology, as well as a review of the toxicology literature. In addition, it made recommendations or suggested guidelines for public health interventions and for future basic science, clinical, and public health research. This is the most up-todate statement on the health effects of molds in indoor air. It includes a good bibliography, and a well-reasoned evaluation of a very difficult area of environmental science. It is available on the World Wide Web through the National Academies Press at www.nap.edu, or the Institute of Medicine at iomwww@nas.edu, and will be available in portable document format (PDF) for printing.