Spirometry and PEFR
Spirometry, the most common type of pulmonary function test (PFT), is used to screen workers for their ability to perform certain tasks
and in in medical surveillance (OSHA).
Spirometry results can play a central role in decisions about worker job assignments and personal protective equipment, and in the assessment of exposure-related health effects.
- The peak expiratory flow (PEF), also called peak expiratory flow rate (PEFR) is a person's maximum speed of expiration, as measured with a peak flow meter, a small, hand-held device used to monitor a person's ability to breathe out air. It measures the airflow through the bronchi and thus the degree of obstruction in the airways.It is a useful screening tool for lung diseases in occupational settings.
- Spirometry is more precise and yields more information than PEFR (AHRQ).
- USPSTF, Recommendation: Do not screen for chronic obstructive pulmonary disease using spirometry (USPSTF 2014).
International standards
a- Offshore: Further tests may be performed at the doctor's discretion, e.g. blood tests, ECG and spirometry.
(Norwegian Directorate of Health 2012)
b- Offshore: Further investigations (e.g. blood tests, ECG, spirometry) may be required to clarify clinical findings but are not a routine.
(UK Offshore Oil and Gas 2008)
c- Offshore: Routinely required: Spirometry to minimally include FVC and FEV1 assessment.
(GoM BP 2012)
d- Fire fighters; Spirometry is required. Pulmonary function testing is conducted to measure the member’s forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and the FEV1/FVC ratio. Data is corrected within American Thoracic Society Guidelines and normative equations. (Knudson et al., 1983 and ACOEM 2000)
(NFPA 2012)
-
Fire fighters; Spirometry is part of the minimum requirements ( AFAC 2006).
f- Divers; spirometry is required for initial and annual medical examinations.
(HSE UK, MA1, 2011)
g- Hazardous Occupations; Not a routine test, Workers with poor effort or tolerance, or with history of unstable angina, may have difficulty doing strenuous exercise and carrying the heavy air-supplied respirators. Where indicated, lung function tests and stress ECG can be carried out.
(Hong Kong 2004)
h- OSHA Standard; Hazardous Waste Operations and Emergency Responses (HAZWOPER): spirometry is required for HAZMAT team members and emergency response team.
In addition, spirometry is an OSHA requirements that apply when testing workers exposed to regulated substances such as asbestos, coke oven emissions, cotton dust, cadmium, formaldehyde, and benzene.
(OSHA 2009)
f- Commercial driving; spirometry is not required for initial pre-emp (UK DVLA 2014).
- Suggested indications: Lung function tests is required for divers and fire fighters other occupations are subject to the doctor's discretion, and to exempt office based employees.
References
- Kronick, R. (2014). The Guide to Clinical Preventive Services. USPSTF. Retrieved from http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/cpsguide.pdf
- Guidelines - health requirements for persons working on installations offshore. Norwegian Directorate of Health 2012.
- Medical Aspects of Fitness for Work Offshore ( 2008 The United Kingdom Offshore Oil and Gas)
- GoM Medical Aspects of Fitness for Offshore Work Safety Work Practice (BP 2012)
- NFPA 1582, Chapter 6 Medical Evaluations of Candidates - 2012
- Australasian Fire Authorities Council (AFAC) Medical Guidelines for Firefighters, 2006
- HSE UK, The medical examination and assessment of divers (MA1) 2011, http://www.hse.gov.uk/Diving/ma1.pdf
- Doctors’ Guide to Medical Examinations for Workers engaged in Hazardous Occupations in Industrial Undertakings - Occupational Safety and Health – 2004, Hong Kong.
- OSHA, Screening and Surveillance: A Guide to OSHA Standards, 2009 https://www.osha.gov/Publications/osha3162.pdf
- At a glance Guide to the current Medical Standards of Fitness to Drive'. Drivers Medical Group, DVLA, UK, May 2014
