대한임상검사과학회지 (Korean Journal of Clinical Laboratory Science)

  • 제55권4호
  • /
  • Pages.276-283
  • /
  • 2023
  • /
  • 1738-3544(pISSN)
  • /
  • 2288-1662(eISSN)
대한임상검사과학회 (Korean Society for Clinical Laboratory Science)
권호 표지
DOI QR코드

DOI QR Code

근로자건강진단 폐활량검사에서 새로운 신뢰성기준 적용 결과

New Reliability Criteria for Korean Workers' Health Examination Spirometry Results

  • 원용림 (산업안전보건연구원 직업건강연구실) ;
  • 이화연 (산업안전보건연구원 직업건강연구실) ;
  • 이지혜 (산업안전보건연구원 직업건강연구실)
  • Yong Lim WON (Department of Occupational Health Research, Occupational Safety and Health Research Institute) ;
  • Hwa-Yeon LEE (Department of Occupational Health Research, Occupational Safety and Health Research Institute) ;
  • Jihye LEE (Department of Occupational Health Research, Occupational Safety and Health Research Institute)
  • 투고 : 2023.10.12
  • 심사 : 2023.11.07
  • 발행 : 2023.12.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

산업안전보건연구원에서는 현재 2005년 미국흉부학회(American Thoracic Society, ATS)와 유럽호흡기학회(European Respiratory Society, ERS)의 폐활량검사 표준화가이드를 준용하여 근로자건강진단 폐활량검사를 평가하고 있으며, 2019년 ATS/ERS가이드의 적용을 검토하고 있다. 새로운 평가기준에 따른 결과를 현재 결과와 비교해보고 우리나라 근로자건강진단에 적용하는 것이 적절한지 확인하기 위해 특수건강진단기관으로부터 수집한 325건의 폐활량검사 결과를 검토하였다. 외삽용적, 보정오차, FIVC 등의 평가기준을 더 엄격하게 적용하였음에도 검사의 신뢰성 점수가 상승한 기관이 더 많았다. 주요원인은 FEV1, FVC의 적합성과 재현성을 분리하여 판단함과 동시에 점수를 ATS 등급에 따라 차별 부여하므로 감점 폭이 감소했기 때문으로 파악된다. 새로운 기준을 적용하면 현재 부적합하다고 판단하는 자료의 활용이 가능하므로 검사자와 판정의사의 결과선별과 해석에 대한 이해도를 높인다면 검사자와 수검자 모두가 검사에 대한 부담감을 줄이면서 신뢰성 있는 결과를 얻을 수 있을 것으로 기대한다.

The Occupational Safety and Health Research Institute is currently evaluating spirometry tests used for worker health examinations by applying the 2005 American Thoracic Society (ATS) and European Respiratory Society (ERS) spirometric test standardization guide and reviewing the application of the 2019 ATS/ERS guide. To compare results obtained using the new evaluation criteria with previous results and determine whether it is appropriate to apply them to Korean workers' health examinations, we reviewed spirometry results from 325 special health examination institutions. Although evaluation criteria such as extrapolation volume, correction error, and forced inspiratory vital capacity were applied more strictly, institutions had higher reliability scores. Primarily because the acceptability and repeatability of forced expiratory volume in 1 second and forced vital capacity were judged separately, and thus, deduction width was reduced. The study shows that adopting the new evaluation criteria would reduce the possible use of inappropriate data, increase tester and doctor understanding of result selection and interpretation, increase result reliability, and reduce the testing burden.

키워드

과제정보

This research was supported by Occupational Safety and Health Research Institute.

참고문헌

  1. Ministry of Employment and Labor (MOEL). Occupational safety and health acts [Internet]. MOEL [cited 2023 October 1]. Available from: https://www.law.go.kr/LSW/lsInfoP.do?efYd=20220818&lsiSeq=234717#0000
  2. Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, et al. General considerations for lung function testing. Eur Respir J. 2005;26:153-161. https://doi.org/10.1183/09031936.05.00034505
  3. Standardization of spirometry, 1994 update. American thoracic society. Am J Respir Crit Care Med. 1995;152:1107-1136. https://doi.org/10.1164/ajrccm.152.3.7663792
  4. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26: 319-338. https://doi.org/10.1183/09031936.05.00034805
  5. Townsend MC; Occupational and Environmental Lung Disorders Committee. Spirometry in the occupational health setting--2011 update. J Occup Environ Med. 2011;53:569-584. https://doi.org/10.1097/jom.0b013e31821aa964
  6. van Schalkwyk EM, Schultz C, Joubert JR, White NW; South African Thoracic Society Standards of Spirometry Committee. Guideline for office spirometry in adults, 2004. S Afr Med J. 2004; 94(7 Pt 2):576-587.
  7. Swanney MP, O'Dea CA, Ingram ER, Rodwell LT, Borg BM; ANZSRS Spirometry Training Course Working Group. Spirometry training courses: content, delivery and assessment - a position statement from the Australian and New Zealand Society of Respiratory Science. Respirology. 2017;22:1430-1435. https://doi.org/10.1111/resp.13133
  8. BTS guidelines for the management of chronic obstructive pulmonary disease. The COPD Guidelines Group of the Standards of Care Committee of the BTS. Thorax. 1997;52 Suppl 5:S1-S28. https://doi.org/10.1136/thx.52.2008.S1.5
  9. Korean Academy of Tuberculosis and Respiratory Diseases. 2016 guidelines for lung function test. Medrang: 2016. p1-34.
  10. Korea Occupational Safety and Health Agency (KOSHA). Guidelines for spirometry and interpretation. Research report. Ulsan: KOSHA; 2021 October. p5-60.
  11. Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005;26:948-968. https://doi.org/10.1183/09031936.05.00035205
  12. Won YL, Kim EA, Park JS, Park KY. Current status of and measures to standardize spirometry findings in special health examinations. Research report. Ulsan: Occupational Safety and Health Research Institute; 2019 November. p37-50.
  13. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of lung function testing: the authors' replies to readers' comments. Eur Respir J. 2010;36:1496-1498. https://doi.org/10.1183/09031936.00130010
  14. Occupational Safety and Health Research Institute (OSHRI). Guidelines for workers' health examination - volume 1: overview of special health examination. OSHRI: 2012. p80-88.
  15. Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Hall GL, et al. Standardization of spirometry 2019 update. An Official American Thoracic Society and European Respiratory Society Technical Statement. Am J Respir Crit Care Med. 2019; 200:e70-e88. https://doi.org/10.1164/rccm.201908-1590st
  16. Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15:155-163. https://doi.org/10.1016/j.jcm.2016.02.012 Erratum in: J Chiropr Med. 2017;16:346.
  17. Moore VC. Spirometry: step by step. Breathe. 2012;8:232-240. https://doi.org/10.1183/20734735.0021711
  18. Townsend MC. Spirometry in occupational health - 2020. J Occup Environ Med. 2020;62:e208-e230. https://doi.org/10.1097/JOM.0000000000001851
  19. Culver BH, Graham BL, Coates AL, Wanger J, Berry CE, Clarke PK, et al. Recommendations for a standardized pulmonary function report. An Official American Thoracic Society Technical Statement. Am J Respir Crit Care Med. 2017;196:1463-1472. https://doi.org/10.1164/rccm.201710-1981st
  20. Lee JH, Won YL, Lee HY, Lee YS. Improvement of quality control standards in the field of spirometry for Workers's Specific Health Examinations. Research report. Ulsan: Occupational Safety and Health Research Institute; 2022 November. p.80-81.