Annals of Occupational and Environmental Medicine

  • Volume 34
  • /
  • Pages.14.1-14.14
  • /
  • 2022
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  • 1225-3618(pISSN)
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  • 2052-4374(eISSN)
The Korean Society of Occupational & Environmental Medicine (대한직업환경의학회)
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A proposal of spirometry reference equations for Korean workers

  • Yonglim Won (Department of Occupational Health Research, Occupational Safety and Health Research Institute) ;
  • Hwa-Yeon Lee (Department of Occupational Health Research, Occupational Safety and Health Research Institute)
  • Received : 2022.03.15
  • Accepted : 2022.06.06
  • Published : 2022.12.31
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Abstract

Background: Although spirometry results can be interpreted differently depending on the reference equation used, there are no established criteria for selecting reference equations as part of the special health examinations for Korean workers. Thus, it is essential to examine the current use of reference equations in Korea, quantify their impact on result interpretation, and propose reference equations suitable for Korean workers, while also considering the environmental conditions of special health examination facilities. Methods: The 213,640 results from the special health examination database were analyzed to identify changes in the ratio of measured values to reference values of lung capacity in Korean workers with changes in age or height, and changes in the agreement of interpretations with the reference equation used. Data from 238 organizations that participated in the 2018-2019 quality control assessment by the Korea Occupational Safety and Health Agency were used to identify the spirometer model and reference equations used in each special health examination facility. Results: Korean special health examination facilities used six reference equations, and the rate of normal or abnormal ventilatory diagnoses varied with the reference equation used. The prediction curve of the Global Lung Function Initiative 2012-Northeast Asian (GLI2012) equation most resembled that of the normal group, but the spirometry model most commonly used by examination facilities was not compliant with the GLI2012 equation. With a scaling factor of 0.95 applied to the Dr. Choi equation, the agreement with the GLI2012 equation was > 0.81 for men and women. Conclusions: We propose the GLI2012 equation as reference equation for spirometry in Korean workers. The GLI2012 equation exhibited the most suitable prediction curve against the normal lung function group. For devices that cannot use the GLI2012 equation, we recommend applying a scaling factor of 0.95 to the Dr. Choi equation.

Keywords

Acknowledgement

The authors thank Dr. Deog Hwan Moon, Inje University Graduate School of Public Health, for his advice for this study.

References

  1. Ministry of Employment and Labor. 2018 Workers' Health Examination report. https://www.moel.go.kr/info/publicdata/majorpublish/majorPublishView.do;jsessionid=0iIovOH1yaqaNP6ZiCmTOIXFEb7yweIMNSh1aIslT0R9knD3VL75slGHC1cMnd8g.moel_was_outside_servlet_www1?bbs_seq=20191200959. Updated 2019. Accessed January 19, 2022.
  2. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J 2005;26(2):319-38.
  3. American Thoracic Society. Lung function testing: selection of reference values and interpretative strategies. Am Rev Respir Dis 1991;144(5):1202-18.
  4. Choi JK, Paek D, Lee JO. Normal predictive values of spirometry in Korean population. Tuberc Respir Dis (Seoul) 2005;58(3):230-42.
  5. Eom SY, Moon SI, Yim DH, Lee CH, Kim GB, Kim YD, et al. Goodness-of-fits of the spirometric reference values for Koreans and USA Caucasians to spirometry data from residents of a region within Chungbuk province. Tuberc Respir Dis (Seoul) 2012;72(3):302-9.
  6. Occupational Safety and Health Research Institute (OSHRI). Overview of special health examination. In: Guidelines for Workers' Health Examination, Volume 1. Ulsan, Korea: OSHRI; 2021, 169-70.
  7. Korea Occupational Safety and Health Agency (KOSHA). Guidelines for spirometry and interpretation (KOSHA GUIDE H-129-2021). https://www.kosha.or.kr/kosha/info/searchTechnicalGuidelines.do. Updated 2021. Accessed January 19, 2022.
  8. Eom SY, Kim H. Reference values for the pulmonary function of Korean adults using the data of Korea National Health and Nutrition Examination Survey IV (2007-2009). J Korean Med Sci 2013;28(3):424-30.
  9. Jo BS, Myong JP, Rhee CK, Yoon HK, Koo JW, Kim HR. Reference value for spirometry derived using lambda, mu, sigma (LMS) method in Korean adults: in comparison with previous references. J Korean Med Sci 2018;33(3):e16.
  10. Myong JP, Koo JW, Kim HR, Lee HE, Jo BS, Lee JW, et al. Evaluation and Development of Judgement Criteria for Spirometry in Worker's Health Examination. 2016-OSHRI-767. Ulsan, Korea: OSHRI; 2016.
  11. Quanjer PH, Stanojevic S, Cole TJ, Baur X, Hall GL, Culver BH, et al. Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations. Eur Respir J 2012;40(6):1324-43.
  12. Townsend MC; American College of Occupational and Environmental Medicine. ACOEM guidance statement: Spirometry in the occupational health-2020. J Occup Environ Med 2020;62(5):e208-30.
  13. Occupational Safety and Health Administration (OSHA). Spirometry testing in occupational health program (OSHA 3637-03 2013). https://www.osha.gov/Publications/OSHA3637.pdf. Updated 2013. Accessed January 26, 2022.
  14. Won YL, Kim EA, Park JS, Park GY. Current Status of and Measures to Standardize Spirometry Findings in Special Health Examinations. 2019-OSHRI-1533. Ulsan, Korea: OSHRI; 2019.
  15. Enforcement Decree of the Occupational Safety and Health Act of Korea. Article 209 (Reporting of health examination results). November 19, 2021.
  16. Occupational Safety and Health Act. Article 135 (Special health examination facilities). November 19, 2021.
  17. Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease: GOLD Executive Summary. Am J Respir Crit Care Med 2017;195(5):557-82.
  18. Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretative strategies for lung function tests. Eur Respir J 2005;26(5):948-68.
  19. Kory RC, Callahan R, Boren HG, Syner JC; Clinical Spirometry in Normal Men. The Veterans Administration-Army cooperative study of pulmonary function. I. Clinical spirometry in normal men. Am J Med 1961;30(2):243-58.
  20. Morris JF, Koski A, Johnson LC. Spirometric standards for healthy nonsmoking adults. Am Rev Respir Dis 1971;103(1):57-67.
  21. Smith AA, Gaensler EA. Timing of forced expiratory volume in one second. Am Rev Respir Dis 1975;112(6):882-5.
  22. American Thoracic Society (ATS). ATS statement--Snowbird workshop on standardization of spirometry. Am Rev Respir Dis 1979;119(5):831-8.
  23. Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Hall GL, et al. Standardization of spirometry 2019 update. An official American thoracic society and European respiratory society technical statement. Am J Respir Crit Care Med 2019;200(8):e70-88.
  24. Hankinson JL, Odencrantz JR, Fedan KB. Spirometric reference values from a sample of the general U.S. population. Am J Respir Crit Care Med 1999;159(1):179-87.
  25. Knudson RJ, Lebowitz MD, Holberg CJ, Burrows B. Changes in the normal maximal expiratory flow-volume curve with growth and aging. Am Rev Respir Dis 1983;127(6):725-34.
  26. Korotzer B, Ong S, Hansen JE. Ethnic differences in pulmonary function in healthy nonsmoking Asian-Americans and European-Americans. Am J Respir Crit Care Med 2000;161(4 Pt 1):1101-8.
  27. Vaz Fragoso CA, McAvay G, Gill TM, Concato J, Quanjer PH, Van Ness PH. Ethnic differences in respiratory impairment. Thorax 2014;69(1):55-62.
  28. Lee JO, Choi BS. Changes of pulmonary disability grades according to the spirometry reference equation. Tuberc Respir Dis (Seoul) 2010;69(2):108-14.
  29. Oh YM, Hong SB, Shim TS, Lim CM, Koh Y, Kim WS, et al. Effect of a new spirometric reference equation on the interpretation of spirometric patterns and disease severity. Tuberc Respir Dis (Seoul) 2006;60(2):215-20.
  30. Wang ML, McCabe L, Petsonk EL, Hankinson JL, Banks DE. Weight gain and longitudinal changes in lung function in steel workers. Chest 1997;111(6):1526-32.
  31. Bottai M, Pistelli F, Di Pede F, Carrozzi L, Baldacci S, Matteelli G, et al. Longitudinal changes of body mass index, spirometry and diffusion in a general population. Eur Respir J 2002;20(3):665-73.
  32. Thyagarajan B, Jacobs DR Jr, Apostol GG, Smith LJ, Jensen RL, Crapo RO, et al. Longitudinal association of body mass index with lung function: the CARDIA study. Respir Res 2008;9(1):31.
  33. Wang ML, Avashia BH, Petsonk EL. Interpreting longitudinal spirometry: weight gain and other factors affecting the recognition of excessive FEV1 decline. Am J Ind Med 2009;52(10):782-9.
  34. Kubota M, Kobayashi H, Quanjer PH, Omori H, Tatsumi K, Kanazawa M, et al. Reference values for spirometry, including vital capacity, in Japanese adults calculated with the LMS method and compared with previous values. Respir Investig 2014;52(4):242-50.
  35. McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb) 2012;22(3):276-82.