Surveillance for lung disease. Quality assurance using computers and a team approach.

An occupational pulmonary surveillance program will detect the lung diseases that affect about 20% of the general population: asthma, chronic bronchitis, emphysema, restrictive disorders, and lung cancer. Annual spirometry testing and standardized respiratory questionnaires are useful components of all programs, but because many problems with spirometry testing and interpretation occur, a team approach is indicated. In order to minimize the false-positive rate, an expert in pulmonary surveillance should be included to help choose a good spirometry system, train technicians, monitor the quality of their work, and interpret the results. Interpretation of annual change in pulmonary function enhances the ability to detect lung disease early but requires knowledge of the test-retest reproducibility of the FEV1 of your own surveillance program.