Official american thoracic society technical standards: Spirometry in the occupational setting

Carrie A. Redlich, Susan M. Tarlo, John L. Hankinson, Mary C. Townsend, William L. Eschenbacher, Susanna G. Von Essen, Torben Sigsgaard, David N. Weissman

Research output: Contribution to journalArticlepeer-review

88 Scopus citations


Purpose: 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.

Original languageEnglish (US)
Pages (from-to)984-994
Number of pages11
JournalAmerican Journal of Respiratory and Critical Care Medicine
Issue number8
StatePublished - Apr 15 2014


  • FEV1
  • Longitudinal spirometry
  • Medical surveillance
  • Occupational
  • Spirometry

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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