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Workplace Spirometry: Early Detection Benefits Individuals, Worker Groups and Employers

Case Editor - Kamyar Afshar

Reviewed By Environmental & Occupational Health Assembly

Submitted by

Leslie Israel DO, MPH

Associate Clinical Professor

Department of Medicine, Division of Occupational and Environmental Medicine

University of California, Irvine

Irvine, California

Thomas Kim MD, MPH

Medical Officer/Epidemic Intelligence Service Officer

California Department of Public Health

Centers for Disease Control and Prevention

Janice Prudhomme DO, MPH

Occupational Health Branch, Hazard Evaluation System and Information Service

California Department of Public Health

Rachel Bailey DO, MPH

Medical Officer

National Institute for Occupational Safety and Health, Division of Respiratory Disease Studies

Centers for Disease Control and Prevention

Philip Harber MD, MPH

Professor, Chief

Department of Family Medicine, Division of Occupational and Environmental Medicine

University of California, Los Angeles

Submit your comments to the author(s).

History

A food flavoring manufacturing facility offers periodic workplace spirometry testing to its employees. The testing is done by medical professionals at the worksite without charge to the employees. Results for one employee are shown in Table 1.


Measurements

10/31/06

3/13/07

Repeated on 3/14/07

Pre-BD

Post-BD*

Pre-BD

Post-BD*

FVC (L)

6.38

5.96

5.82

5.77

5.67

FVC

Percent predicted

113.5%

106.2%

 

102.8%

 

FEV1 (L)

4.10

3.06

3.09

3.02

3.02

FEV1

Percent predicted

86.5%

64.5%

 

63.7%

 

FEV1/FVC

64.4%

51.3%

53.0%

52.3%

53.3%


Table 1. Spirometry findings during medical surveillance at workplace.

*No significant improvement in FVC or FEV1 with bronchodilator. †Lower limit of normal: 89.2% FVC, forced vital capacity; FEV1, forced expiratory volume in the first second of exhalation; L, liter; BD, bronchodilator; %, percent.

The employee, a 25-year-old man assigned to mixing food flavorings, is found to have an abnormal spirogram during routine workplace medical surveillance. He is referred for evaluation to an occupational environmental medicine (OEM) physician in March 2007. The employee reports his general health status is good and denies respiratory symptoms.

The OEM physician obtains an occupational history as follows: No prior occupational history of direct exposures to chemicals or other toxic agents. From 1995 to 2000, he fed animals (primarily cattle) on a farm in Mexico, and from 2001 to 2004, he worked in the warehouse and shipping departments at various companies. In December 2004, he began working for a temporary agency that placed him at the food flavoring plant. In June 2005, he was hired by the food flavoring company and worked in flavoring production. He reportedly used a dust mask on occasion. In February 2006, he began using a half-facepiece air-purifying respirator. In September 2006, he was given a full-facepiece respirator. Fit-testing had not been done on the half-or full-facepiece respirators until January 2007 when he was quantitatively fit-tested for a full-facepiece respirator.

He denies any prior medical history of pulmonary disease or chronic medical conditions. He denies any allergies. He takes no prescribed or over-the-counter medications. His family history is negative for pulmonary disease. He reports occasional cigarette smoking for one year in 2004 - 2005.

He does not have any pets in his home. He denies any hobbies or second jobs (such as auto repair, construction, or other tasks that would involve possible exposures to pulmonary toxicants). His leisure time activities include: family gatherings, jogging and playing soccer.

Figures


Figure 1: High-resolution computed tomography (HRCT) of chest performed on April 17, 2007.

Question 1

What is the most likely diagnosis?


References

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