title: Official American Thoracic Society technical standards: spirometry in the occupational setting.
abstract: OBJECTIVE
  This document addresses aspects of the performance and interpretation of spirometry that are particularly important in the workplace, where inhalation exposures can affect lung function and cause or exacerbate lung diseases, such as asthma, chronic obstructive pulmonary disease, or fibrosis.
  
  
  METHODS
  Issues that previous American Thoracic Society spirometry statements did not adequately address with respect to the workplace were identified for systematic review. Medline 1950-2012 and Embase 1980-2012 were searched for evidence related to the following: training for spirometry technicians; testing posture; appropriate reference values to use for Asians in North America; and interpretative strategies for analyzing longitudinal change in lung function. The evidence was reviewed and technical recommendations were developed.
  
  
  RESULTS
  Spirometry performed in the work setting should be part of a comprehensive workplace respiratory health program. Effective technician training and feedback can improve the quality of spirometry testing. Posture-related changes in FEV1 and FVC, although small, may impact interpretation, so testing posture should be kept consistent and documented on repeat testing. Until North American Asian-specific equations are developed, applying a correction factor of 0.88 to white reference values is considered reasonable when testing Asian American individuals in North America. Current spirometry should be compared with previous tests. Excessive loss in FEV1 over time should be evaluated using either a percentage decline (15% plus loss expected due to aging) or one of the other approaches discussed, taking into consideration testing variability, worker exposures, symptoms, and other clinical information.
  
  
  CONCLUSIONS
  Important aspects of workplace spirometry are discussed and recommendations are provided for the performance and interpretation of workplace spirometry.
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Redlich
authors.forename: Susan M
authors.initials: SM
authors.lastname: Tarlo
authors.forename: John L
authors.initials: JL
authors.lastname: Hankinson
authors.forename: Mary C
authors.initials: MC
authors.lastname: Townsend
authors.forename: William L
authors.initials: WL
authors.lastname: Eschenbacher
authors.forename: Susanna G
authors.initials: SG
authors.lastname: Von Essen
authors.forename: Torben
authors.initials: T
authors.lastname: Sigsgaard
authors.forename: David N
authors.initials: DN
authors.lastname: Weissman
mesh_terms: D001249:Asthma / Q000175:diagnosis / Q000209:etiology; D019317:Evidence-Based Medicine; D005541:Forced Expiratory Volume; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis* / Q000209:etiology*; D009784:Occupational Diseases / Q000175:diagnosis* / Q000209:etiology*; D016273:Occupational Exposure / Q000009:adverse effects*; D009787:Occupational Medicine / Q000592:standards*; D011159:Population Surveillance; D011187:Posture; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000209:etiology; D011658:Pulmonary Fibrosis / Q000175:diagnosis / Q000209:etiology; D012016:Reference Values; D013147:Spirometry / Q000592:standards*; D014481:United States