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Sunday, May 8, 2011

SPIROLA: A solution for more effective use of periodic spirometry

While mortality rates for most chronic illnesses (heart disease, malignancy, stroke) have declined in the U.S., mortality from chronic obstructive pulmonary disease (COPD) has increased over the past 3 decades. COPD is the fourth-leading cause of death and the second leading cause of disability in the United States. Blue-collar workers have the highest prevalence of chronic obstructive pulmonary disease (COPD) in the country. The main cause of COPD is abnormal inflammatory response of the lung to inhalation of noxious particles and gases, with tobacco smoking being the most prevalent risk factor. Most cases of obstructive or restrictive respiratory diseases are preventable.

Evidence shows that in occupational settings with exposure to respiratory hazards, maintaining worker's respiratory health is important not only for workers' health but for reducing companies' and individuals' health-related costs.1-6 The National Institute for Occupational Safety and Health (NIOSH) new WorkLife initiative supports a new approach to reduce workplace hazards and promote worker safety, health, and well-being, which reflects the growing appreciation of the complexity of influences on worker health and the interactions between work-based and non-work factors. This kind of approach is particularly important in promoting workers' respiratory health since the adverse effects of occupational and non-occupational hazards often cannot be discerned in respiratory disease. While the chronic effects of smoking and occupational exposure usually lead to a relatively small additional annual decrement in lung function during the early years of life, the lung function deterioration starts to escalate around 40 years of age in susceptible individuals. Additionally, abdominal obesity, prevalent in the U.S. workforce, usually causes restrictive pattern of impairment, and increased risk of metabolic syndrome and cardiovascular disease and diabetes.

Spirometry is a pulmonary function test measuring the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled. Periodic spirometry can provide a valuable tool for early recognition and prevention of respiratory diseases and for maintaining workers' respiratory health and general fitness. Spirometry can assist the health professional by determining if a worker demonstrates a specific pattern of respiratory impairment and can help to assess the effectiveness of measures implemented to prevent further lung function deterioration. In addition, results from defined groups of workers can be evaluated in relation to potential workplace hazards. When using periodic spirometry in the workplace, reliable baseline spirometry measurements must be established followed by good quality periodic spirometry and the evaluation of changes over time. The American College of Occupational and Environmental Medicine (ACOEM) provides guidelines on workplace periodic spirometry testing and interpretation. NIOSH approves courses in spirometry for instruction of those administering screening pulmonary function testing to employees exposed to occupational hazards. NIOSH also provides a list of course sponsors, course audit and sponsorship renewal dates, schedule of courses, and instructor resources, such as a training manual, available on the NIOSH Topic Page Spirometry in the Occupational Setting.

NIOSH recently developed computer software for Spirometry Longitudinal Data Analysis (SPIROLA) to enhance healthcare providers' capacity in managing and interpreting periodic spirometry.7-11 SPIROLA is designed to assist healthcare providers in: monitoring spirometry data precision and quality; applying interpretative strategies to identifying individuals who may experiencing excessive loss of lung function (i.e., those at risk of developing disabling lung function impairment); integrating and evaluating longitudinal spirometry, questionnaire responses, and information on potential risk factors for decision-making; designing, recoding, and implementing intervention plans; and subsequent evaluation of the effect of intervention in individuals and a group.

The software can be downloaded for free from the NIOSH Topic Page Spirometry in the Occupational Setting for accomplishing (i to ii), and on request from Spirola@cdc.gov to accomplish (iii-v). See an example of a SPIROLA chart below:

Screen capture of a SPIROLA chart

If you conduct workplace periodic spirometry we invite you to share your experiences by posting on this blog. We would specifically be interested in posts addressing:

How periodic spirometry results are used in your setting including potential barriers to using spirometry results for prevention How an individual's spirometry measurement changes are evaluated over time for example by:visual inspection of the longitudinal spirometry results,calculating changes over time using a computer, comparing results to ATS or ACOEM interpretation guidelines for annual or longer follow-up changes, orif not evaluated, describe the barriers to evaluating changes in spirometry measurements over time.Barriers to computerizing spirometry dataYour experiences, if any, with Spirometry Longitudinal Data Analysis (SPIROLA) softwareYour thoughts about additional assistance that NIOSH could provide to promote use of periodic spirometry for respiratory disease prevention.

—Eva Hnizdo, Ph.D., and Lu-Ann Beeckman-Wagner, Ph.D.

Dr. Hnizdo is a senior service fellow in the NIOSH Division of Respiratory Disease Studies. Her research focus is on epidemiological research into longitudinal spirometry and medical monitoring for occupational lung diseases.

Dr. Beeckman-Wagner is a Health Scientist in NIOSH's Division of Respiratory Disease Studies and the program director for the NIOSH-Approved Spirometry Training Program.

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Posted 12/14/09 at 12:45 pm


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