Spirometry Monitoring Technology

The primary method of preventing occupational respiratory disease is through control or elimination of adverse exposures in the workplace. Even with exposure controls in place, some workers may be affected by hazardous exposure. Spirometry monitoring is recommended for persons with occupational exposure to respiratory hazards, and 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.

Spirometry monitoring should be done to prevent development of disabling chronic lung function impairment through early intervention on excessive lung function loss.

To achieve this objective, it is important:

1. to maintain acceptable quality of the spirometry data;
2. to 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. to couple results of health monitoring to effective intervention strategies.

Spirometry Longitudinal Data Analysis (SPIROLA)

SPIROLA software is an easy-to-use visual and quantitative tool intended to assist the health care provider (HCP) in monitoring and interpreting computerized longitudinal spirometry data for individuals as well as for a group. Listed below are some of the features SPIROLA provides.

1. Evaluation of longitudinal spirometry data in individuals:
1. Display of forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and percent predicted values (Figure) plotted against age, for each individual in the database. Cross-sectional and longitudinal limits shown on the chart can be selected by the user.
2. Comparison of the most recent spirometry test results to population reference values derived from standard or user-specified reference equations (FEV1, FVC, and FEV/FVC).
3. Evaluation of changes in FEV1 over time. For the first 8 years of an individual’s follow-up, SPIROLA uses the limit of longitudinal decline (LLD) to determine whether or not the individual’s decline in FEV1 may be excessive.(Figure)  After 8 years of follow-up, the age at which the individual may be expected to develop moderate-severe lung function impairment (Figure) is taken into consideration in the evaluation.
4. Reporting results of cross-sectional and longitudinal evaluation in an individual’s report. (Figure)
5. Screening for individuals with abnormal findings. (Figure) This function automatically identifies individuals who may experience excessive decline in FEV1 or whose most recent test is below LLN, for further evaluation. The selection criteria, based on both cross-sectional and longitudinal evaluation, can be modified by the user.
6. Selecting individuals into a tag list  for further evaluation (e.g., spirometry quality control or retesting), occupational safety evaluation, intervention, or referral for a medical examination.(Figure)
7. Monitoring of the impact of interventions on lung function change for individuals and for a group. (Figure)
   
   
2. Monitoring of longitudinal spirometry data precision and spirometry test quality.
1. Monitoring the precision of longitudinal spirometry data for a group of program participants.(Figure) This function helps in assuring that data precision remains acceptable over time, and provides an appropriate basis upon which to calculate a limit of longitudinal decline (LLD) for use as a criterion to evaluate longitudinal decline.
2. Monitoring the percentage of spirometry tests that do not meet the 2005 ATS/ERS criteria for acceptability and repeatability, overall and by a technician (Figure). This function helps to assure acceptable data quality and precision by each spirometry technician. (Figure)

SPIROLA software is easy to install and test-run with a demonstration database (names in the database are fictional) included with the software. See the User Manual for details on installation, software functions, and instructions for data input. Please send us your questions or comments on SPIROLA.

User manual (1 MB, 37 pages) (includes detailed installation instructions)

Software Download (1.5 MB) (Beta Version - last updated June 30, 2008. See disclaimers and note below.) (Save this file to your computer and run to install the software.)

Disclaimer (1): This software is provided to assist health care practitioners in their management of occupational medical monitoring programs using spirometry. The software is only intended to assist the user in assembling the information required to make medical decisions, but cannot be substituted for competent and informed professional judgment. NIOSH does not warrant the reliability or accuracy of the software, graphic screens, or text. Software users need to be aware of all applicable federal, state and local laws and regulations that may impact utilization of this software.

Disclaimer (2): This information is distributed solely for the purpose of pre-dissemination peer review under applicable information quality guidelines. It has not been formally disseminated by the National Institute for Occupational Safety and Health. It does not represent and should not be construed to represent any agency determination or policy.

Note: This is a DRAFT Beta version which may undergo some additional revisions, if required, following formal NIOSH stakeholder review and final approvals. It is requested that users of this beta version of the SPIROLA program provide us with feedback on your experiences.

Publications Relevant to SPIROLA

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: Evaluating Pulmonary Function Change Over Time in the Occupational Setting. JOEM 2005; 47:1307-1316.
   External link: http://www.acoem.org/guidelines.aspx?id=756
   
3. 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.
4. 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.
5. 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.
6. 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.
7. 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.
8. 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.
9. Hankinson JL, Wagner GR. Medical screening using periodic spirometry for detection of chronic lung disease. Occup Med: State Art Rev 1993; 8:353-361.
10. Harber P, Lockey JE. Pulmonary function testing in pulmonary prevention. Occup Med: State Art Rev 1991; 6:69-79.
11. Enright PL. Surveillance for lung disease. Quality assurance using computers and a team approach. Occup Med: State Art Rev 1992; 7:209-225.
12. Enright PL. How to make sure your spirometry tests are of good quality. Respir Care 2003; 48:773-776.
13. 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.           

NIOSHTIC-2 Search

NIOSHTIC-2 Search Results on Spirometry Monitoring
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.

Other suggested search terms: longitudinal spirometry; longitudinal lung function;  lung function monitoring; lung function screening