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SPIROMETRY

Spirometry Monitoring Technology

Screen capture of SPIROLA software

Spirometry monitoring can be used in the primary, secondary, and tertiary prevention of occupational and non-occupational respiratory disease and in the maintenance of workers’ fitness. Primary prevention of occupational respiratory disease through control or elimination of adverse exposures in the workplace is a priority. With respect to primary prevention, spirometry monitoring of workers can be used to assess the respiratory health status of subgroups of workers exposed to a particular agent (or production process) to determine if exposures to that agent (or production process) is unsafe and needs to be controlled. However, even with exposure controls in place, some workers may be adversely affected; such residual occupational risks and non-occupational exposures (e.g., tobacco smoke) provide a role for spirometry monitoring in secondary and tertiary prevention. With respect to secondary prevention, spirometry can be used to monitor worker populations exposed to potential respiratory hazards to identify otherwise healthy individuals who are experiencing excessive lung function decline; individualized preventive intervention can then be applied to prevent further excessive loss and subsequent lung function impairment. With respect to tertiary prevention, spirometry can be used to carefully monitor an individual worker with established lung function impairment and/or symptoms as part of clinical management to help prevent disabling impairment and limit symptoms. Generally, respiratory disease prevention is best done as part of an overall health maintenance program in which results of spirometry evaluations are linked with exposure control, smoking cessation, and general health-promotion interventions.

To achieve the above objectives, it is important to:

  1. maintain acceptable quality of the spirometry data;
  2. apply an interpretative strategy that has a high likelihood of promptly identifying individuals with excessive loss of lung function who are at increased risk of developing disabling lung function impairment;
  3. couple results of health monitoring to effective group and individual intervention strategies.

Spirometry Longitudinal Data Analysis (SPIROLA) Software

SPIROLA software is an easy-to-use visual and quantitative tool intended to assist the health care provider in monitoring and interpreting computerized longitudinal spirometry data for individuals as well as groups. It can be used for primary, secondary, and tertiary prevention (see above).

Evaluation of longitudinal spirometry data in individuals

  1. SPIROLA enables the user to display forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and percent predicted values (Figure) plotted against age, as single or multiple charts (Figure), for each individual in the database (Cross-sectional and longitudinal limits shown on the chart can be selected by the user).
  2. SPIROLA enables the user to compare the most recent spirometry test results to population reference values derived from standard or user-specified reference equations (FEV1, FVC, and FEV1/FVC).
  3. SPIROLA enables the user to evaluate changes in FEV1 and FVC over time. For the first 8 years of an individual’s follow-up, SPIROLA uses the limit of longitudinal decline (LLD) which takes into account expected within-person variation in FEV1 or FVC and the duration of follow-up to determine whether or not the individual’s decline in FEV1 or FVC may be excessive (blue line in Figure). After 8 years of follow-up, the age at which the individual is projected to develop moderate-severe lung function impairment is considerate in the evaluation (Figure). Results of the cross-sectional and longitudinal evaluation are provided in an individual’s report.

Screening for individuals with abnormal findings

  1. SPIROLA enables the user to identify for further evaluation individuals whose most recent spirometry test results are below LLN values or who may experience excessive decline in FEV1 or FVC. The selection criteria are based on published reference values and can be modified by the user (Figure).
  2. SPIROLA enables the user to tag identified individuals for further spirometry evaluation such as spirometry quality control or retesting (Figure).

Planning, recoding and evaluating an intervention

  1. SPIROLA’s intervention module enables the user to develop a comprehensive intervention program for respiratory disease prevention for a group of workers and to implement the intervention plan in individuals (Example, Figure).
  2. SPIROLA enables the user to monitor and evaluate the implementation of intervention for individuals and for a group of workers.

Evaluation of longitudinal spirometry data in a group

  1. SPIROLA enables the user to monitor group means for (FEV1) and (FVC) and in relation to mean predicted values based on group demographics (age, height, gender, ethnicity/race).
  2. SPIROLA enables the user to monitor the precision of longitudinal spirometry data for a group of participants (Figure). This function helps in assuring that data precision remains acceptable over time, and provides an appropriate basis upon which to determine a limit of longitudinal decline (LLD) for use as a criterion to evaluate longitudinal decline.

Standardized questionnaire survey

  1. SPIROLA V3.0 enables the user to conduct an electronic questionnaire survey for respiratory symptoms, occupational and non-occupational risk factors, and workplace exposure. The questionnaire data stored in SPIROLA can be integrated into decision-making in developing intervention plans for individuals and a group. Also, the data can be exported as a CSV file (Figure).

Monitoring spirometry test quality

  1. SPIROLA enables the user to monitor the percentage of spirometry tests that do not meet the 2005 ATS/ERS criteria for acceptability and repeatability, for individual technicians and overall. This function helps to assure acceptable data quality and precision by each spirometry technician (Figure).

New in Version 3.0.1

The version 3.0.1 includes the following new features or functions:
  1. The FILE menu in SPIROLA allows the user to create an empty Microsoft Access or Excel database in a SPIROLA format. Spirometry data can be imported or entered into the database (see user manual for details).
  2. Longitudinal limit has been added to the FVC chart to enable identification of individuals with excessive decline in FVC.
  3. The RISK LIST functions have been expanded to allow identification of individuals with excessive decline in FVC (Figure).
  4. The OPTIONS menu allows specification of the longitudinal limit for FVC, and of what height value is to be used for the cross-sectional evaluation (the mean or the most recent value).

Changes in Version 3.0

Version 3.0 includes the following enhancements and additions. Please refer to the SPIROLA user manual for details.
  1. Intervention module
    1. to design and implement intervention
    2. to conduct Safety or Lifestyle Assessment at Worksite
  2. Questionnaire module
    1. to design a questionnaire
    2. to conduct electronic questionnaire survey
    3. to clean the questionnaire survey data
    4. to view and export questionnaire data
  3. Data input from various types of spirometry databases is supported:
    1. Microsoft Access
    2. Microsoft SQL Server
    3. Other ODBC-compliant databases
    4. Custom data input support for datasets created by different types of spirometers
  4. Flexible data format support (cm/in, l/ml, different date formats, race and gender values)
  5. SPIROLA can be started from third party applications (i.e., from another software)

References:

  1. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CPM, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G and Wanger J. Standardization of spirometry. ATS/ERS task force: Standardization of lung function testing. Ed. Brusasco V, Crapo R and Viegi. Eur Respir J 2005; 26:319-338.
  2. ACOEM Position Statement. Spirometry in the Occupational Health Setting– 2010 Update. Occupational and Environmental Lung Disorders Committee.
  3. Hnizdo E, Glindmeyer HW, Petsonk EL. Workplace spirometry monitoring for respiratory disease prevention: a method review. Int J Tuberc Lung Dis 2010: 14(7):796-805.
  4. Hnizdo E, Yan T, Enright P, Beeckman-Wagner L, Hankinson J, Fleming J, Petsonk EL. Spirometry Longitudinal Data Analysis software (SPIROLA) for analysis of spirometry data in workplace prevention or COPD treatment. Open Med Inform J; 2010: 4:94-102.
  5. Hnizdo E, Berry A, Hakobyan A, Beeckman-Wagner L-A, Catlett L. Worksite wellness program for respiratory disease prevention in heavy construction workers. J Occup Environ Med, 2011:53:274-281.
  6. Baughman P, Marott JL, Lange P, Hnizdo E. Health outcomes associated with lung function decline and respiratory symptoms and disease in a community cohort. COPD: Int J Chron Obstruct Pulmon Dis 2011: 48:103-113.
  7. Hnizdo E, Sircar K, Yan T, Harber P, Fleming J, Glindmeyer HW. Limits of longitudinal decline for the interpretation of annual change in FEV1 in individuals. Occup Environ Med 2007; 64: 701-707.
  8. Wang ML, Vashia BH, Petsonk EL. Interpreting periodic lung function tests in individuals. The relationship between 1- to 5-year and long-term FEV1 changes. Chest 2006; 130:493-499.
  9. Hnizdo E, Sircar K, Glindmeyer HW, Petsonk EL. Longitudinal limits of normal decline in lung function in an individual. J Occup Environ Med 2006; 48:625-634.
  10. Hnizdo E, Yu L, Freyder L, Attfield M, Lefante J, Glindmeyer HW. Precision of longitudinal lung function measurements—monitoring and interpretation. Occup Environ Med 2005; 62:695-701.
  11. Wang ML, Petsonk EL. Repeated measures of FEV1 over six to twelve months: what change is abnormal? J Occup Environ Med 2004; 46:591-595.
  12. Hankinson JL, Wagner GR. Medical screening using periodic spirometry for detection of chronic lung disease. Occup Med: State Art Rev 1993; 8:353-361.
  13. Harber P, Lockey JE. Pulmonary function testing in pulmonary prevention. Occup Med: State Art Rev 1991; 6:69-79.
  14. Enright PL. Surveillance for lung disease. Quality assurance using computers and a team approach. Occup Med: State Art Rev 1992; 7:209-225.
  15. Enright PL. How to make sure your spirometry tests are of good quality. Respir Care 2003; 48:773-776.
  16. Becklake MR, White N. Sources of variation in spirometric measurements. Identifying the signal and dealing with the noise. Occup Med: State Art Rev 1993; 8:241-261.
  17. Sircar K, Hnizdo E, Petsonk E, Attfield M. Decline in lung function and mortality: implication for medical monitoring. Occup Environ Med 2007; 64:461-466.

NIOSHTIC-2 is a searchable bibliographic database of occupational safety and health publications, documents, grant reports, and journal articles supported in whole or in part by NIOSH.

Relevant suggested search terms: spirometry monitoring, longitudinal spirometry; longitudinal lung function; lung function monitoring; lung function screening.

 
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