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Spirometric reference values in the occupational medicine practice.

Dante Luigi Cioffi, Veruscka Leso, Umberto Carbone

  • 1Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Naples, Italy.

Toxicology and Industrial Health
|April 14, 2020
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Summary

Choosing spirometry reference values impacts lung function interpretation. The Global Lung Initiative (GLI) 2012 identified more obstructive and mixed patterns than older ECSC 1971 and ERS 1993 values.

Keywords:
ECSC 1971ERS 1993GLI 2012Pulmonary function testhealth surveillancereference valuesspirometry interpretation

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Area of Science:

  • Occupational Medicine
  • Pulmonary Function Testing
  • Respiratory Physiology

Background:

  • Spirometry is crucial in occupational medicine for assessing lung function.
  • Interpretation accuracy relies heavily on the chosen reference values.
  • Variations in reference values can lead to different diagnostic conclusions.

Purpose of the Study:

  • To retrospectively evaluate differences in spirometric interpretation based on distinct reference values.
  • To compare the impact of European Coal and Steel Community (ECSC) 1971, European Respiratory Society (ERS) 1993, and Global Lung Initiative (GLI) 2012 values.

Main Methods:

  • Analysis of 2462 spirometries from occupational health surveillance.
  • Comparison of Forced Vital Capacity (FVC), FEV1, and FEV1/FVC ratio across ECSC 1971, ERS 1993, and GLI 2012 reference values.

Main Results:

  • GLI 2012 yielded higher mean FVC and FEV1 than ERS 1993, but lower than ECSC 1971.
  • GLI 2012 detected all obstructive and mixed patterns found by ECSC 1971 and ERS 1993, plus additional cases.
  • GLI 2012 identified fewer restrictive patterns than ERS 1993 but more than ECSC 1971.

Conclusions:

  • ERS 1993 values underestimated obstructive and restrictive changes compared to GLI 2012.
  • ECSC 1971 values underestimated obstructive changes and overestimated restrictive patterns versus GLI 2012.
  • GLI 2012 offers a potentially more accurate interpretation, but requires validation in Italian workers.