Male physician listens to female patient's heart with stethoscope

With Pulmonary Function Tests, Healthy Breathing is the Goal

By Michelle Hopkins | 04/10/2019

If you have never heard of – or understood – pulmonary function tests, you are about to discover why they are a valuable component of a respiratory protection program and how they serve as an indispensable safety net for both you, as the employer, and your employees with potential exposure to respirable hazards.

Under the federal respiratory protection standard (29 CFR 1910.134), the Occupational Health and Safety Administration (OSHA) requires employers to develop and implement a written respiratory protection program if airborne contaminants in the workplace exceed permissible exposure limits or employers require employees to use respirators to protect against hazardous respirable exposures.

Across many industries, hazardous chemicals are a fact of life – either as a material used directly or as a byproduct of a production or manufacturing process. OSHA has defined four potential methods of contact with hazardous substances: inhalation, skin contact, swallowing or ingestion, and injection. The most common is inhalation.

Calculations show that the average person breathes in about six liters (or 1.59 gallons) of air each minute – along with any contaminants the air contains. Employees who do hard physical work may inhale more than 2,800 liters (almost 740 gallons) of air in the average eight-hour working day.1

OSHA Citations and Penalties

To get a picture of situations when respirable exposures of substances can occur, here are some events that elicited OSHA citations and penalties in 2018:

  • Employees of an aircraft manufacturer were exposed to airborne concentrations of hexavalent chromium, a known carcinogen, at nearly two times the permissible exposure limit.
  • Employees of a machine manufacturer were exposed to hazardous chemical vapors during a degreasing operation in an enclosed space.
  • Employees of a moving and storage company were exposed to asbestos and silica hazards during an office renovation project.
  • Employees of a battery company were exposed to airborne lead at levels 11 times the permissible exposure limit.
  • Employees of a pallet manufacturer were exposed to carbon monoxide 10 times the permissible exposure limit.
  • Employees at an oil refinery were exposed to hazardous chemicals from machinery used in a shutdown operation.

OSHA’s respiratory protection standard (29 CFR 1910.134) requires not only a written respiratory protection program, but also these elements:

  • A hazard evaluation by the employer to identify and assess respiratory hazards in the workplace
  • Respirator fit testing for employees, and not just upon hire. When a tight-fitting facepiece respirator is to be worn, and whenever a different facepiece (size, style, model or make) is used, a fit test needs to be conducted; in addition, fit tests need to be conducted at least annually
  • Development of specific worksite procedures as part of the respiratory protection program, including medical evaluations, fit testing, respirator cleaning and storage, and employee training in proper respirator use and potential respirable hazards2

Employers can use help complying with OSHA’s respiratory protection requirements. The respiratory protection standard has had a prominent place on the agency’s top 10 list of most cited violations for at least the better part of a decade. For seven consecutive years, it was listed at number four.2 In 2018, it moved to number three.3

 Among the reasons OSHA cited employers for violations under this standard in 2018 included a failure to:

  • Implement proper engineering controls
  • Conduct air monitoring or sampling
  • Provide training to employees
  • Require employees to properly remove potentially contaminated personal protective equipment before leaving the area
  • Assess the need for respirators
  • Develop a respiratory protection program
  • Use ventilation systems and respirators
  • Properly ventilate a confined space
  • Have an emergency rescue plan in place

Proper respiratory protection is imperative. Before wearing a respirator, employees must be medically evaluated, using OSHA’s mandatory medical questionnaire or an equivalent method. Concentra® uses the OSHA questionnaire and includes a full medical history. Concentra clinicians also may conduct a physical examination, which may include a pulmonary function test.

What is a Pulmonary Function Test?

Pulmonary function tests are an essential component of your respiratory protection program because they measure an employee’s lung function. When performed on a new hire, a pulmonary function test can identify employees who may not be suited to wearing a respirator or working in an environment where there are potential hazardous exposures.

The information gained from respiratory health surveillance, including medical evaluation and pulmonary function testing, may lead to detection of early lung disease. Detecting lung disease early allows for earlier access to management and treatment. Pulmonary function tests truly are a safety net for employees.

Spirometry is the most common pulmonary function test. Concentra uses spirometry to measure:

  • Air volume breathed out, or forced vital capacity (FVC)
  • Air volume expelled in one second, or forced expiratory volume in one second (FEV1) and
  • The relationship between the two (the FEV1/FVC ratio)

Clinicians can use any of these tests (or a combination of them) to examine results over time to diagnose a worsening condition or a need for work restriction or medical treatment.

To be compliant, pulmonary function tests must be performed by technicians who have been certified by completing a spirometry training course approved by the National Institute of Occupational Safety and Health (NIOSH).  Concentra® has a large contingent of certified technicians in every region where there is demand for pulmonary function tests.

Pulmonary Function Tests: Role in Respiratory Protection

We have talked about pulmonary function tests as a valuable component of respiratory protection in your occupational health and safety program, but what exactly does that entail?

First, it’s important to understand that OSHA requires pulmonary function testing only in the medical surveillance provisions of standards related to specific substances, such as asbestos, cotton dust, benzene, formaldehyde and, more recently, silica and beryllium.

OSHA’s respiratory protection standard (29 CFR 1910.134) requires an employee’s health and physical condition to be assessed to determine if he or she is able to safely wear a respirator in the performance of job duties. The standard does not require any specific procedure, such as pulmonary function tests, but Concentra’s 40 years of experience in occupational health supports the value of this method.

Pulmonary function tests help give you confidence in meeting OSHA’s requirement to provide a safe and healthful workplace. Industries newly affected by the respiratory protection standard, such as dental laboratories using beryllium and glass manufacturers using silica, are just some of the workplaces that can benefit from a Concentra medical surveillance consultation.

We understand you need pulmonary function tests to be uncomplicated and easy to schedule. That’s why Concentra offers single-point access to our certified technicians. They are available along with all our other occupational health services at most of our more than 520 community-based medical centers.

What Is It Like to Have a Pulmonary Function Test?

An employee scheduled for a spirometry test may have questions about how it is done.

First, you can assure your employee that the test is non-invasive. In a spirometry test, the individual blows into a mouthpiece that is connected to a tabletop device called a spirometer. Concentra’s certified technicians will demonstrate the testing device and the importance of standing straight, not bending the neck, and correct placement of the mouthpiece. The mouthpiece goes behind the front teeth and lips to form a seal around it before blowing forcefully, when instructed to do so.

During the test, a nose clip is worn to ensure that all air exits through the mouth for measurement. The test is done multiple times because results of three acceptable spirometry test readings are needed. Forceful breathing like this may cause an individual to feel light-headed or cough. The technician will address these potential concerns before the test and stand behind the individual, even offering support with a hand on the shoulder, as a safeguard in case of light-headedness.

To prepare for a spirometry test, tell your employee:

  • Do not smoke for at least an hour before the test.
  • Do not exercise heavily for at least 30 minutes before the test.
  • Do not eat a large meal within two hours before the test.
  • Do not wear tight-fitting clothing that makes it more difficult for you to breathe.
  • Ask the clinician if there are any medications you should avoid taking before the test.

All of these activities can interfere with achieving a good spirometry test.

Answering an Objection That You May Hear

Sometimes, employees don’t want to take a pulmonary function test because they worry the results might restrict their ability to return to work. Concentra technicians understand these concerns and help educate employees about pulmonary function testing.

Employees are not expected to have a super hero standard of lung function; understanding this and how test results are evaluated can help alleviate any concerns. Pulmonary function tests are viewed in two ways.

First, pulmonary function test results are interpreted by comparing the individual’s results with the results predicted for a person of the same gender, age, height, and race (all demographic factors that may be associated with differences in lung performance).

Second, pulmonary function tests from the same individual over time can help identify when lung function is beginning to decline so this can be addressed with treatment or work modifications.

Bottom Line in Pulmonary Function Testing

Pulmonary function testing, as part of a respiratory protection program, helps you manage and reduce work-related lung injuries from inhaled respirable hazardous exposures. When provided by Concentra’s certified technicians, you can be sure you are getting not only best-in-class occupational health care and testing, but also the most complete knowledge of current respiratory standards and compliance fulfillment. As the nation’s occupational health leader, Concentra performs approximately 140,000 pulmonary function tests annually.

Protect your employees and avoid an OSHA penalty. 

Sources:

1 “How Workplace Chemicals Enter the Body,” Canadian Center for Occupational Health and Safety, updated February 3, 2017. https://www.ccohs.ca/oshanswers/chemicals/how_chem.html

2 “Respiratory protection in the workplace,” Worksite Medical, January 11, 2017 www.worksitemed.com/top-five-respiratory-protection-citations-from-2016

3 “OSHA’s Top 10 Most Cited Violations of 2018,” October 23, 2018. https://www.msdsonline.com/2018/10/23/oshas-top-10-most-cited-violations-of-2018/