AOCOPM 2023 Midyear Educational Conference-259668

259668 - Article 6
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The AOCOPM 2023 Midyear Educational Conference featured various challenging spirometry cases relevant to occupational medicine practitioners. The presentation by Carl Werntz, D.O., MPH, from Morgantown Occupational Medicine focused on several key topics dealing with individuals with specific conditions that could affect spirometry results, namely lobectomy, transgender identity, obesity, pneumonectomy, stroke, and Parkinson’s disease. <br /><br />For lobectomy patients, medical literature reviews have shown a significant decrease, approximately 15-20%, in forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1) post-surgery. Recommendations were to adopt a conservative approach when adjusting predicted values, prompting a 20% decrease adjustment for FVC and FEV1, maintaining the FEV1/FVC ratio unchanged.<br /><br />Regarding transgender individuals, challenges arise because current spirometry equations rely on gender/sex as a determinant. Misclassification risks exist based on gender-affirming treatments, making adjustments necessary according to the individual's development stage at puberty rather than their current hormonal status.<br /><br />Obesity's impact on spirometry often results in lung volume changes, with significant spirometric changes manifesting mainly at a BMI over 40. Obesity hypoventilation syndrome, linked with severe health conditions, demonstrates the need for careful assessment of lung function beyond just obesity attribution.<br /><br />Pneumonectomy patients show a considerable reduction in FVC and FEV1 (around 40%). Adjustments for predicted values are necessary for accurate spirometry results interpretation.<br /><br />In stroke and Parkinson's disease scenarios, literature is sparse and less conclusive. In Parkinson’s cases, assessments rely on the Hoehn and Yahr scale for disease severity; lung function tends to decrease as disease severity increases, emphasizing the importance of tailored spirometry interpretation.<br /><br />These cases highlight the need for nuanced spirometry interpretation considering various physiological and medical factors to ensure accurate diagnosis and management.
Keywords
AOCOPM 2023
spirometry cases
occupational medicine
Carl Werntz
lobectomy
transgender identity
obesity
pneumonectomy
stroke
Parkinson's disease