TY - JOUR
T1 - How frequently should workplace spirometry screening be performed?
T2 - Optimization via analytic models
AU - Harber, Philip
AU - Levine, Jessica
AU - Bansal, Siddharth
N1 - Funding Information:
Author contributions: All three authors contributed to the design and analysis, helped draft the article, and have provided final approval of the submission. Financial/nonfinancial disclosures: Dr. Harber has served the following organizations with a direct interest in occupational surveillance: the American College of Occupational and Environmental Medicine (Board of Directors, Pulmonary Committee, and Treatment Guidelines Committee); the American Thoracic Society (Committee on Work Exacerbated Asthma); and Centers for Disease Control and Prevention-National Institute for Occupational Safety and Health (Centers for Disease Control and Prevention-National Institute for Occupational Safety and Health; the Committee on Work Exacerbated Asthma, Study Section). He has received research funding from Centers for Disease Control and Prevention-National Institute for Occupational Safety and Health for projects related to the recognition and prevention of occupational lung diseases. As part of the practice of occupational pulmonary medicine, Dr. Harber has served as a consultant or medical expert in workers' compensation or other cases of work-related illness, and he has provided other consulting services involving possible work-related respiratory disorders. Ms. Levine and Dr. Bansal have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
PY - 2009/10/1
Y1 - 2009/10/1
N2 - Background: Our objective was to determine how to select the optimal frequency of workplace spirometry screening using diacetyl-exposed workers as an example. Methods: A Markov model was constructed to assess the likelihood of progressing from healthy status to early or advanced disease, starting from four different exposure levels, and performing longitudinal or cross-sectional interpretation of spirometry results over time. Projected outcomes at 10 years were evaluated to inform the optimal frequency of workplace spirometry testing. Results: The optimal screening interval depends on the population risk and is highly sensitive to the real-life impact (utility) associated with false-positive results (eg, related to the availability of alternative work). Screening interval is particularly important for high-risk individuals with rapid transition from early to advanced disease, where the 10-year prevalence of advanced disease would be reduced from 5.3 to 2.5% using a 6-month interval rather than a 12-month interval. Longitudinal test interpretation, based on observing trends within each person over time, is marginally preferable to traditional cross-sectional spirometry interpretation. Conclusions: There is no single best screening interval. For high-risk populations, annual testing may be too infrequent.
AB - Background: Our objective was to determine how to select the optimal frequency of workplace spirometry screening using diacetyl-exposed workers as an example. Methods: A Markov model was constructed to assess the likelihood of progressing from healthy status to early or advanced disease, starting from four different exposure levels, and performing longitudinal or cross-sectional interpretation of spirometry results over time. Projected outcomes at 10 years were evaluated to inform the optimal frequency of workplace spirometry testing. Results: The optimal screening interval depends on the population risk and is highly sensitive to the real-life impact (utility) associated with false-positive results (eg, related to the availability of alternative work). Screening interval is particularly important for high-risk individuals with rapid transition from early to advanced disease, where the 10-year prevalence of advanced disease would be reduced from 5.3 to 2.5% using a 6-month interval rather than a 12-month interval. Longitudinal test interpretation, based on observing trends within each person over time, is marginally preferable to traditional cross-sectional spirometry interpretation. Conclusions: There is no single best screening interval. For high-risk populations, annual testing may be too infrequent.
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U2 - 10.1378/chest.09-0237
DO - 10.1378/chest.09-0237
M3 - Article
C2 - 19411294
AN - SCOPUS:70350112419
VL - 136
SP - 1086
EP - 1094
JO - Diseases of the chest
JF - Diseases of the chest
SN - 0012-3692
IS - 4
ER -