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Longitudinal lung function declines among California flavoring manufacturing workers.
Kreiss K; Fedan KB; Nasrullah M; Kim TJ; Materna BL; Prudhomme JC; Enright PL
Am J Ind Med 2012 Aug; 55(8):657-668
Background The California Department of Public Health received serial spirometry data for flavoring manufacturing workers at 20 companies at risk of bronchiolitis obliterans. Methods We graded spirometry quality; identified individual workers with excessive decline in forced expiratory volume in 1 s (FEV1) using relative longitudinal limits of decline based on 4% average within-person variability; and analyzed declines by occupational risk factors. Results The quality of 1,697 spirometry tests from 725 workers varied by 18 providers, with poorer quality from commercial providers. Of 416 workers with at least two tests, 40 (9.6%) had abnormal FEV1 decline. Of 289 workers with high quality spirometry, 21 (7.3%) had abnormal decline. Only one of the 21 had airways obstruction. Abnormal FEV1 decline rates (per person-month) were greater among workers at companies using greater than or equal to 800 lbs/year diacetyl than at companies using lesser amounts. Abnormal FEV1 decline rates were greater at companies previously having four-person clusters of spirometric obstruction than at companies with no or only one worker with obstruction. Conclusions Spirometric surveillance of flavoring workers can identify individual workers with an abnormal FEV1 decline for preventive intervention, even when the FEV1 itself remains within the normal range. Good quality spirometry and classification of abnormal with relative longitudinal limit of decline minimize misclassification of possible work-related health effects.
Lung-disease; Lung-disorders; Lung-function; Lung-irritants; Occupational-respiratory-disease; Pulmonary-disorders; Pulmonary-function; Pulmonary-function-tests; Pulmonary-system; Pulmonary-system-disorders; Quantitative-analysis; Respiratory-function-tests; Respiratory-hypersensitivity; Respiratory-irritants; Respiratory-system-disorders; Spirometry; Statistical-analysis; Author Keywords: bronchiolitis obliterans; flavoring; diacetyl; spirometry; surveillance
Kathleen Kreiss, MD, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, 1095 Willowdale Road Mailstop H-2800,Morgantown,WV 26505
Issue of Publication
American Journal of Industrial Medicine
Public Health Institute