Background
According to NIOSH, the number one cause of work related disease and injury in the workplace is Occupational Lung Diseases. This fact, along with the increasing incidence of disabling lung diseases due to cigarette smoking may be sufficient reason for companies to establish an effective spirometry – respiratory surveillance system as part of an overall risk management program. A companies surveillance program should be designed to track the four critical points in the course of a disease.
Primary prevention is an intervention before biologic onset of the disease. An example is prevention of occupational lung disease by use of protective devices (respirators) to reduce levels of dust to which workers are exposed, or the use of OSHA approved dosimeters and spirometry equipment as part of a surveillance system.
Secondary prevention is an intervention when disease can be detected at a stage before it is symptomatic. This is accomplished by using spirometry test data surveillance information for individual or group trend analysis to detect dynamic changes before they become abnormal.
Tertiary prevention or Control is used to define intervention after the onset of identifiable symptoms through entry into the health care system in order to delay, arrest or reverse the course of COPD. An example is discouragement of smoking for individuals, a measure that will arrest or even reverse condition.
Economics
An effective respiratory screening and surveillance program can result in significant health cost savings to a business. It has been shown that the yearly costs to identify and treat workers with moderately advanced CRD is four fold greater than if the condition had been detected in its mild state, and eleven fold greater when identified in its severely advanced state. Given the average 14 year life span remaining to those diagnosed with severe CRD, the accumulated health care costs alone are impressive.
Program Requirements
A complete program of respiratory screening requires both a test of lung function, spirometry, (the only test available to primary care physicians for the early detection of COPD,) and a rigorous Respiratory symptom Questionnaire which elicits important symptoms of respiratory dysfunction, smoking habits and previous work history. This spectrum of information, when used knowledgably, allows for the early detection of Chronic Respiratory Disease.
The Success of such a screening program and any subsequent surveillance is dependant upon:
- Use of accurate and precise spirometry equipment, approved for use by OSHA
- Development of written Standard Operating Procedures and their enforcement in the field.
- Use of technicians who have undergone NIOSH approved training and certification.
- Standardization of measurement procedures and data categorization
- Continuing quality control of data acquisition procedures in the field and resultant data records
- Knowledgeable interpretation of individual data for clinical care and group data analysis for epidemiological studies