Estimates of restrictive ventilatory defect in the mining industry. Considerations for epidemiological investigations: a cross-sectional study

Objectives (1) To assess the impact of American Thoracic Society and European Respiratory Society (ATS/ERS) ‘acceptability’ and ‘usability’ criteria for spirometry on the estimates of restrictive ventilatory defect in a population of taconite miners. (2) To compare estimates of restrictive ventilatory defect with three different pulmonary function tests (spirometry, alveolar volume (VA) and diffusing capacity (DL,CO)). (3) To assess the role of population characteristics on these estimates. Design Cross-sectional study. Setting Current and former workers in six current taconite mining operations of northeastern Minnesota were surveyed. Participants We attempted to enrol 3313 participants. Of these, 1353 responded while 1188 current and former workers fully participated in the survey and 1084 performed complete pulmonary function testing and were assessed. Primary and secondary outcome measures We applied ATS/ERS acceptability criteria for all tests and categorised participants into groups according to whether they fully met, partially met or did not meet acceptability criteria for spirometry. Obstruction and restriction were defined utilising the lower limit of normal for all tests. When using VA, restriction was identified after excluding obstruction. Results Only 519 (47.9%) tests fully met ATS/ERS spirometry acceptability criteria. Within this group, 5% had obstruction and 6%, restriction on spirometry. In contrast, among all participants (N=1084), 16.8% had obstruction, while 4.5% had restriction. VA showed similar results in all groups after obstruction was excluded. Impaired gas transfer (reduced DL,CO) was identified in less than 50% of restriction identified by either spirometry or VA. Body mass index (BMI) was significantly related to spirometric restriction in all groups. Conclusions Population estimates of restriction using spirometry or VA varied by spirometric acceptability criteria. Other factors identified as important considerations in the estimation of restrictive ventilatory defect included increased BMI and gas transfer impairment in a relatively smaller proportion of those with spirometric restriction. These insights are important when interpreting population-based physiological data in occupational settings.

[1]  J. Martin,et al.  Effect of panting frequency on the plethysmographic determination of thoracic gas volume in chronic obstructive pulmonary disease. , 2015, The American review of respiratory disease.

[2]  A H Morris,et al.  Standardized single breath normal values for carbon monoxide diffusing capacity. , 2015, The American review of respiratory disease.

[3]  R M Gardner,et al.  Reference spirometric values using techniques and equipment that meet ATS recommendations. , 2015, The American review of respiratory disease.

[4]  J. Mead.  Dysanapsis in normal lungs assessed by the relationship between maximal flow, static recoil, and vital capacity. , 2015, The American review of respiratory disease.

[5]  J. Hankinson,et al.  Standardisation of lung function testing: the authors' replies to readers' comments , 2010, European Respiratory Journal.

[6]  C. Pereira,et al.  Predizendo redução da CPT em pacientes com CVF reduzida e relação VEF1/CVF normal ou elevada , 2010 .

[7]  P. Enright.  FEV1 and FVC repeatability goals when performing spirometry. , 2010, Primary care respiratory journal : journal of the General Practice Airways Group.

[8]  Leopold Stiebellehner,et al.  Comparison of plethysmographic and helium dilution lung volumes: which is best for COPD? , 2010, Chest.

[9]  A. Buist,et al.  Comparison of spirometry criteria for the diagnosis of COPD: results from the BOLD study , 2009, European Respiratory Journal.

[10]  J Stocks,et al.  Using the lower limit of normal for the FEV1/FVC ratio reduces the misclassification of airway obstruction , 2008, Thorax.

[11]  S. Verbanck,et al.  Forced vital capacity and forced expiratory volume in six seconds as predictors of reduced total lung capacity , 2008, European Respiratory Journal.

[12]  J. E. Hansen,et al.  Spirometric criteria for airway obstruction: Use percentage of FEV1/FVC ratio below the fifth percentile, not < 70%. , 2007, Chest.

[13]  P. Enright,et al.  A statistical rationale for the use of forced expired volume in 6 s. , 2006, Chest.

[14]  P. Enright,et al.  FEV6 as a surrogate for FVC in detecting airways obstruction and restriction in the workplace , 2006, European Respiratory Journal.

[15]  J. Hankinson,et al.  Interpretative strategies for lung function tests , 2005, European Respiratory Journal.

[16]  J. Hankinson,et al.  Standardisation of the single-breath determination of carbon monoxide uptake in the lung , 2005, European Respiratory Journal.

[17]  G. Viegi,et al.  Standardisation of the measurement of lung volumes , 2005, European Respiratory Journal.

[18]  J. Hankinson,et al.  Standardisation of spirometry , 2005, European Respiratory Journal.

[19]  S. Verbanck,et al.  FEV1/FEV6 and FEV6 as an alternative for FEV1/FVC and FVC in the spirometric detection of airway obstruction and restriction. , 2005, Chest.

[20]  K. Beck,et al.  Clinical significance of elevated diffusing capacity. , 2004, Chest.

[21]  P. Enright,et al.  Spirometry reference values for American Indian adults: results from the Strong Heart Study. , 2001, Chest.

[22]  A. Buist,et al.  Office spirometry for lung health assessment in adults: A consensus statement from the National Lung Health Education Program. , 2000, Chest.

[23]  S. Aaron,et al.  How accurate is spirometry at predicting restrictive pulmonary impairment? , 1999, Chest.

[24]  N M Punjabi,et al.  Correction of single-breath helium lung volumes in patients with airflow obstruction. , 1998, Chest.

[25]  J. Stocks,et al.  Reference values for residual volume, functional residual capacity and total lung capacity. ATS Workshop on Lung Volume Measurements. Official Statement of The European Respiratory Society. , 1995, The European respiratory journal.

[26]  J. Lefante,et al.  Blue-collar normative spirometric values for Caucasian and African-American men and women aged 18 to 65. , 1995, American journal of respiratory and critical care medicine.

[27]  D. Dockery,et al.  The association between health status and the performance of excessively variable spirometry tests in a population-based study in six U.S. cities. , 1987, The American review of respiratory disease.

[28]  Buist As.  Standardization of spirometry. , 1987 .

[29]  M. Petersen,et al.  Spirometry reference values for nonexposed blue-collar workers. , 1985, Journal of occupational medicine. : official publication of the Industrial Medical Association.

[30]  D. Dockery,et al.  Distribution of forced expiratory volume in one second and forced vital capacity in healthy, white, adult never-smokers in six U.S. cities. , 1985, The American review of respiratory disease.

[31]  M. Petersen,et al.  Prevalence of chest symptoms in nonexposed blue-collar workers. , 1984, Journal of occupational medicine. : official publication of the Industrial Medical Association.

[32]  B. Ferris,et al.  Epidemiology Standardization Project (American Thoracic Society). , 1978, The American review of respiratory disease.

[33]  M. Lebowitz,et al.  The maximal expiratory flow-volume curve. Normal standards, variability, and effects of age. , 1976, The American review of respiratory disease.

[34]  E. Weibel,et al.  Morphometric estimation of pulmonary diffusion capacity. VI. Effect of varying positive pressure inflation of air spaces. , 1973, Respiration physiology.

[35]  Theodore Rodman,et al.  Lung Function: Assessment and Application in Medicine , 1965 .

[36]  J. Maurer.  Comparison of Plethysmographic and Helium Dilution Lung Volumes: Which Is Best for COPD? , 2011 .

[37]  A. Rubin,et al.  Predicting reduced TLC in patients with low FVC and a normal or elevated FEV1/FVC ratio. , 2010, Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia.

[38]  A. S. Rubin,et al.  Predicting reduced TLC in patients with low FVC and a normal or elevated FEV 1 /FVC ratio* , ** Predizendo redução da CPT em pacientes com CVF reduzida e relação VEF 1 /CVF normal ou elevada , 2010 .

[39]  J. Hankinson,et al.  Performance of American Thoracic Society-recommended spirometry reference values in a multiethnic sample of adults: the multi-ethnic study of atherosclerosis (MESA) lung study. , 2010, Chest.

[40]  M. Hegewald.  Diffusing Capacity , 2009, Clinical reviews in allergy & immunology.

[41]  J. Stoller,et al.  The Utility of Spirometry in Diagnosing Pulmonary Restriction , 2007, Lung.

[42]  G. Annoni,et al.  Quality of spirometric performance in older people. , 2003, Age and ageing.

[43]  J L Hankinson,et al.  Spirometric reference values from a sample of the general U.S. population. , 1999, American journal of respiratory and critical care medicine.

[44]  E. Weibel.  Morphometric estimation of pulmonary diffusion capacity. I. Model and method. , 1970, Respiration physiology.