Pulmonary function testing in inorganic dust diseases
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Pulmonary Function Testing in Inorganic Dust Diseases. Dr Peri Arbak Duzce University , School of Medicine Department of Chest Diseases. Presentation plan. Pulmonary function tests in inorganic dust diseases Correlation between pulmonary functions and progression of disease

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Pulmonary Function Testing in Inorganic Dust Diseases

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Pulmonary function testing in inorganic dust diseases

PulmonaryFunctionTesting in InorganicDustDiseases

Dr Peri Arbak

DuzceUniversity, School of Medicine

Department of ChestDiseases


Presentation plan

Presentation plan

  • Pulmonaryfunctiontests in inorganicdustdiseases

  • Correlationbetweenpulmonaryfunctionsandprogression of disease

  • Algorithm in longtermpulmonaryfunctionfollow-up

  • What is thelower limit of normal?

  • Why is longtermpulmonaryfunctionfollow-upnecessary?

  • Thepinpointsin longtermpulmonaryfunctionfollow-up

  • Thesignificantchangein longtermfollow-up


Pulmonary function tests in inorganic dust diseases

PulmonaryFunctionTestsin InorganicDustDiseases

  • Pulmonaryfunctiondisordersseen in pneumoconiosismay be restrictive, obstructiveorcombined

  • Testsarelistedbelow;

    1- Forcedexpiratoryflowsincluded FVC, FEV1, FEV1/FVC, MMFR can be measuredeither in workplaceorpulmonaryfunctionlaboratory,

    2- Diffusioncapacityand total lungcapacity can be measured in sophisticatedlaboratoryfacilities,

    3- 6 minutewalking test,

    4- Arterialbloodgases, measurement of pulmonaryarterialpressure,

    5- Cardiopulmonaryexercisetesting.


Pulmonary function testing in inorganic dust diseases

Correlationbetweenpulmonaryfunctionsandprogression of disease(Baum GL, Textbook of PulmonaryDiseases. Vol 1. Philadelphia, Pa: Lippincott-Raven; 1998:683-92.).

  • Simple pneumoconiosis

  • Lowercategories (1)

  • Categories 2-3

  • Focalemphysema

  • B and C opasities

  • Conglomeratedmass

  • No functionimpairment, normal capacity

  • Diffusioncapacity ↓

  • Mildhypoxemia (duetoshunt)

  • Lungcomplianceand

    RV ↑

  • Lungcapacitiesanddiffusion↓

  • Pulmonaryhypertension


Eve bourgkard am j respir crit care med 1998 158 504 509 a longitudinal study

EVE BOURGKARD. AM J RESPIR CRIT CARE MED 1998;158:504–509.A Longitudinal Study


Chuan ing yeoh chang gung med j 2002 25 72 80

Chuan-IngYeoh(ChangGungMed J 2002;25:72-80)


Yws law hkmj vol 7 no 4 december 2001

YWS Law, HKMJ Vol 7 No 4 December 2001


Lu ann f am j respir crit care med vol 163 pp 633 639 2001

LU-ANN F. Am J RespirCrit Care Med Vol 163. pp 633–639, 2001


Meiko taguchi industrial health 2001 39 211 219

Meiko TAGUCHI. Industrial Health 2001, 39, 211–219


Meiko taguchi industrial health 2001 39 211 2191

Meiko TAGUCHI. Industrial Health 2001, 39, 211–219


Meral saygun t berk loz ve toraks dergisi 2001 49 3 359 372

Meral SAYGUN, Tüberküloz ve Toraks Dergisi 2001; 49(3): 359-372


Su ryeon noh chest 137 6 june 2010

Su RyeonNoh, CHEST / 137 / 6 / JUNE, 2010


What is the lower limit of normal

What is thelower limit of normal?

  • Thepointbelow which 5% of nonexposedasymptomaticsubjects (similarage, race, height, gender)are expected to fall is definedas thelower limit of the reference range (LLN)

  • Lower limit of normal foreachsubject can be measuredusingstatisticalprograms

  • http://www.spirxpert.com/GOLD.html


Acoem 2004 mc townsend

ACOEM 2004 (MC Townsend)

1- OSHA- and industry-mandated medicalsurveillanceprograms require health professionals to assess respiratory health using previous and current examination results.

2- Traditionalevaluationof pulmonary function determines whether test results are in the normal range, which is based on asymptomatic non-smokers.


Acoem 2004 mc townsend1

ACOEM 2004 (MC Townsend)

  • 3- Unlike clinic patients, many workers have aboveaveragelungfunction, i.e., >100% Pred. Such lung function can deteriorate dramatically, falling from the top to the bottom of the normal range, without dropping below the normal range. This loss of function will not be detected by simply determining whether each year's test results fall within the traditional normal range.

  • 4- Health professionals must determine whether monitoring change over time is an effective screening test for the outcome disease of interest.


The pinpoints in long term pulmonary function follow up

Thepinpoints in longtermpulmonaryfunctionfollow-up

1- Standardize andDocument the Testing Protocol, Equipment Used, and All Changes in Protocol or Equipment.

2- Technician Training and Periodic QA Audits of Spirograms


Valid test

Valid test


3 equipment

3- Equipment

  • Minimize unnecessaryequipmentchanges,

  • Minimize changes in spirometerconfiguration,

  • Insurespirometeraccuracy;

  • Laboratorytestingof spirometer submitted by manufacturer,

  • Calibration or calibrationchecks at least daily when in use,

  • On-going scrutiny of spirogramsand patterns of test results

  • Retaincalibrationrecordsindefinitely


4 biological variability

4- BiologicalVariability

  • Standardize time of day and season of testing to evaluate long-term change,

  • Postponetesting;

  • For 3 days if subject feels ill,

  • For 3 weeks after severe respiratory or ear infection,

  • For 1 hr after smoking, use of bronchodilator, or a heavy meal,

  • Untilmedically approved after surgery.


Baselines 100 pred

Baselines >100 % Pred

  • Follow-up FEV1% Pred or FVC % Pred falls below Longitudinal Lower Limit of Normal (LNL)

  • [Baseline % Pred x 0.85]

  • A 66-inch tall Caucasian woman was tested periodically from age 30 - 50 years. Is her FVC loss "significant" at age 50? %109X0.85= %93


For baselines 100 pred 1

ForBaselines <= 100 % Pred-1

  • Follow-up Measured FEV1 or FVC falls below Longitudinal Lower Limit of Normal (LNL)

  • [0.85 x Baseline Measured Value - (Baseline Pred - Follow-up Pred)]

  • Slope Steeper than 90-100 ml/yr over 4-6 or More Years


For baselines 100 pred 2

ForBaselines <= 100 % Pred-2

  • A 65-inch tall 67- year old Caucasian woman with Baseline FEV <= 100% Pred was tested annually; biennial results are shown below. Has her FEV1 declined "significantly" by age 69?

  • 2.42 LtX0.85= 2.06Lt

  • Calculateexpectedagingeffect;

  • 2.49-2.43=0.06 [BaselinePred FEV1- Pred FEV1at Age 69]

  • 2.06-0.06= LNL withclearedageeffect=2.00 [0.85 x Baseline FEV1- Expected Aging Effect]


References

References

1- Spirometry in the Occupational Health Setting—2011 Update. Mary C. Townsend. ACOEM GUIDANCE STATEMENT

2-http://www.acoem.org/EvaluatingPulmonaryFunctionChange.aspx


Pulmonary function testing in inorganic dust diseases

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