Spirometry Values for Detecting a Restrictive Pattern in Occupational Health Settings

Background Pulmonary function tests are valuable measures for diagnosis and management of respiratory diseases. In the field of occupational medicine, spirometry is commonly performed, and in a considerable number of spirometries during occupational health evaluations, restrictive pattern is observed without any respiratory symptoms and may necessitate referral of the subject for body plethysmography, which is an expensive test. In this study, we evaluated the diagnostic accuracy of spirometry for detection of restrictive lung pattern in an occupational setting. Materials and Methods In a cross-sectional study from 2008 to 2012, 1224 subjects were selected and entered in the study out of 1,486 individuals referred for annual spirometry. Selected subjects underwent spirometry and body plethysmography. Subjects were divided into two groups of restrictive and non-restrictive patterns and then sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of spirometry for detection of restrictive lung pattern were calculated using total lung capacity measured by plethysmography as the gold standard. Receiver operating characteristic (ROC) curves were used as well. Results Spirometry showed sensitivity, specificity, PPV and NPV of 97.75%, 73.04%, 73.72% and 97.67% for FVC< lower limit of normal (LLN) and 98.68%, 78.00%, 77.31% and 98.83% for FVC< LLN along with FEV1/FVC≥ LLN, respectively. According to the ROC curve, the best cut-off point for FVC for detection of restrictive lung pattern was 70%. Conclusion This study showed that spirometry is a useful method in occupational health evaluations to rule out restrictive lung patterns with acceptable accuracy; however, it is not an accurate tool for detection of restrictive lung pattern in an occupational setting. Simultaneous use of FVC and FEV1/FVC for detection of restriction increases the predictive value of spirometry.

[1]  Wagner Gr,et al.  Medical screening using periodic spirometry for detection of chronic lung disease. , 1993 .

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

[3]  P. Korczynski,et al.  How accurate is spirometry at predicting restrictive pulmonary impairment in children with myasthenia gravis. , 2006, Journal of physiology and pharmacology : an official journal of the Polish Physiological Society.

[4]  M Englert,et al.  [Pulmonary function testing]. , 1976, Bruxelles medical.

[5]  R. Mehra,et al.  Interpreting pulmonary function tests: recognize the pattern, and the diagnosis will follow. , 2003, Cleveland Clinic journal of medicine.

[6]  K. Kilburn,et al.  Measuring lung volumes in advanced asbestosis: comparability of plethysmographic and radiographic versus helium rebreathing and single breath methods. , 1993, Respiratory medicine.

[7]  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.

[8]  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.

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

[10]  P. Clayton,et al.  Lung volumes in healthy nonsmoking adults. , 1982, Bulletin europeen de physiopathologie respiratoire.

[11]  M. Nematbakhsh,et al.  PREDICTION EQUATIONS OF VENTILATORY FUNCTION IN NON-SMOKER ADULTS IN ISFAHAN, IRAN , 2000 .

[12]  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.

[13]  W. Bailey,et al.  Medical Section Of The American Lung Association , 2015 .

[14]  R. Crapo,et al.  Validity of the American Thoracic Society and other spirometric algorithms using FVC and forced expiratory volume at 6 s for predicting a reduced total lung capacity. , 2004, Chest.

[15]  F. Liot,et al.  [RESPIRATORY FUNCTION TESTS]. , 1965, La Revue du praticien.

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

[17]  A. Miller,et al.  Lung function testing: selection of reference values and interpretative strategies. , 1992, The American review of respiratory disease.

[18]  M. Becklake,et al.  Respiratory function tests; normal values at median altitudes and the prediction of normal results. , 1959, American review of tuberculosis.

[19]  M. Franczuk,et al.  Value of Spirometry in Detecting Volume Restriction in Interstitial Lung Disease Patients , 2004, Respiration.

[20]  F. Martinez,et al.  Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. , 2007, American journal of respiratory and critical care medicine.

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

[22]  C B Begg,et al.  Biases in the assessment of diagnostic tests. , 1987, Statistics in medicine.

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

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

[25]  Using Spirometry to Rule Out Restriction in Patients with Concomitant Low Forced Vital Capacity and Obstructive Pattern , 2011, The open respiratory medicine journal.

[26]  S. Aaron,et al.  A spirometry-based algorithm to direct lung function testing in the pulmonary function laboratory. , 2003, Chest.

[27]  Lung function testing: selection of reference values and interpretative strategies. American Thoracic Society. , 1991, The American review of respiratory disease.

[28]  John L. Hankinson,et al.  Standardization of Spirometry, 1994 Update. American Thoracic Society. , 1995, American journal of respiratory and critical care medicine.

[29]  R. Crapo,et al.  FEV(6) is an acceptable surrogate for FVC in the spirometric diagnosis of airway obstruction and restriction. , 2000, American journal of respiratory and critical care medicine.

[30]  J. Clausen.  Prediction of normal values in pulmonary function testing. , 1989, Clinics in chest medicine.

[31]  R. Crapo,et al.  Reference values for lung volumes in an Iranian population: introducing a new equation model. , 2009, Archives of Iranian medicine.

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

[33]  S. Scarlata,et al.  Accuracy of Spirometry in Diagnosing Pulmonary Restriction in Elderly People , 2009, Journal of the American Geriatrics Society.

[34]  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.

[35]  J. E. Hansen,et al.  Should forced expiratory volume in six seconds replace forced vital capacity to detect airway obstruction? , 2006, European Respiratory Journal.

[36]  J. Hankinson,et al.  General considerations for lung function testing , 2005, European Respiratory Journal.

[37]  Medical screening using periodic spirometry for detection of chronic lung disease. , 1993, Occupational medicine.

[38]  Goldman Hi,et al.  Respiratory function tests; normal values at median altitudes and the prediction of normal results. , 1959 .