Spirometry Interpretation Note (Occupational Surveillance)

Header Block

Note Type:	Spirometry Interpretation Note (Occupational Surveillance)
Test Date/Time and Location:	[Test date, time, and testing site]
Surveillance Program:	[Employer program name]; [Regulatory driver if applicable]; [Protocol version if tracked]
Technician:	[Technician name, credentials]
Interpreter:	[Interpreter name, credentials]
Spirometer:	[Device identifier/model]

Subject Information

Name/ID:	[Name or ID per system policy]
Date of Birth or Age at Test:	[DOB or age]
Sex (for reference equation):	[Sex as recorded for reference equation]
Measured Standing Height:	[Measured height with units]
Weight:	[Measured weight with units] (Include if available)
Race/Ancestry:	[Category used for reference equation, or "not required by selected equation"]
Job Title/Department/Worksite:	[Job title]; [Department]; [Worksite]
Exposure Group:	[Exposure group/category] (Include if applicable)
Surveillance Status:	[baseline / periodic / post-exposure / return-to-work / post-incident]

(If measured height is missing or clearly erroneous, insert: "Interpretation deferred—measured height required.")

Reason for Test

[Indication, exposures of concern, surveillance objective, and program-specific thresholds if applicable] (2–4 sentences. State the indication, exposure(s) and duration if known, objective, and any program thresholds. Avoid diagnostic labeling.)

Symptoms and Risk Factors

• Respiratory symptoms since last test: [Cough, wheeze, dyspnea, chest tightness, sputum; frequency/severity; work-related pattern if present]
• Acute illness potentially affecting test validity: [yes / no]; [Details if yes]
• Smoking/vaping status: [never / former / current]; [Pack-years if available]
• Respirator use and tolerance: [Type; usage; tolerance issues if any]

(If symptoms/risk factors were not assessed, state: "Symptoms/risk factors: not assessed this encounter.")

Quality Assessment

• Session Quality Grades:
  • Pre-bronchodilator: FEV1 grade [A–F]; FVC grade [A–F]
  • Post-bronchodilator: FEV1 grade [A–F]; FVC grade [A–F] (Include only if bronchodilator testing performed)
• Maneuvers: [Number attempted]; [Number acceptable]
• Repeatability: [met / not met]
• Technician comments: [Specific issues if present: cough in first second, early termination, hesitation, variable effort, submaximal inspiration, leaks, other]
• Curves reviewed: [yes / no] (If no: "Automated values reviewed without curves—interpretation limited.")
• Interpretability Statement: [Acceptable and repeatable—full interpretation / Usable but not fully acceptable—interpretation limited, consider repeat testing / Not interpretable—repeat required before clinical conclusions]

Spirometry Results

Reference equation: [GLI-2012 / NHANES III / other—specify]

Best FEV1 and best FVC from same maneuver: [yes / no]

Pre-bronchodilator values

Parameter	Observed	Predicted	LLN	Z-score	% Pred
FEV1 (L)	[FEV1 obs]	[FEV1 pred]	[FEV1 LLN]	[FEV1 z]	[FEV1 %pred]
FVC (L)	[FVC obs]	[FVC pred]	[FVC LLN]	[FVC z]	[FVC %pred]
FEV1/FVC	[Ratio obs]	[Ratio pred]	[Ratio LLN]	[Ratio z]	[Ratio %pred]

Bronchodilator testing: [performed / not performed]

(If not performed: "Bronchodilator response testing: not performed.")

Post-bronchodilator details (Include only if performed)

• Agent/Dose/Route: [Agent]; [Dose]; [Route]
• Timing: Administration [time]; Post-test interval [minutes]

Parameter	Observed (Post)	Predicted	LLN	Z-score	% Pred
FEV1 (L)	[FEV1 post]	[FEV1 pred]	[FEV1 LLN]	[FEV1 z post]	[FEV1 %pred post]
FVC (L)	[FVC post]	[FVC pred]	[FVC LLN]	[FVC z post]	[FVC %pred post]
FEV1/FVC	[Ratio post]	[Ratio pred]	[Ratio LLN]	[Ratio z post]	[Ratio %pred post]

• FEV1 change: [Absolute L]; [% of predicted]
• FVC change: [Absolute L]; [% of predicted]

Interpretation

Interpretation validity: [Statement referencing quality assessment above—gate interpretation depth to session quality]

Ventilatory Pattern: [normal / obstructive pattern / possible restriction (low FVC with preserved ratio—unconfirmed without lung volumes) / mixed pattern / non-specific pattern (preserved ratio impairment)] (Classify using LLN-based approach. Use cautious language such as "consistent with" or "suggests." Do not diagnose restrictive lung disease from spirometry alone.)

Severity: [Severity grade]; Method: [z-score categories per ERS/ATS / % predicted categories per program requirement]

Bronchodilator Response: [Meets / Does not meet] responsiveness criteria (Include if tested. Note that responsiveness does not equate to a specific diagnosis.)

Additional comments: [Comments on data quality, physiologic plausibility, or need for confirmatory testing] (Do not infer occupational causation from spirometry alone.)

Longitudinal Comparison

(Include when prior acceptable spirometry exists. If none, state: "No acceptable baseline available for longitudinal comparison.")

Test	Date	FEV1 (L; %pred)	FVC (L; %pred)	FEV1/FVC	Quality (FEV1/FVC)
Baseline	[Date]	[Value; %pred]	[Value; %pred]	[Ratio]	[Grade/Grade]
Most recent prior	[Date]	[Value; %pred]	[Value; %pred]	[Ratio]	[Grade/Grade]
Current	[Date]	[Value; %pred]	[Value; %pred]	[Ratio]	[Grade/Grade]

• Comparability: Posture [consistent / inconsistent]; Reference equation [same / different]; Device class [same / different]
• Change from baseline: FEV1 % predicted change: [Value]; Program threshold: [Value, e.g., 15%]; Excessive decline: [yes / no]
• Confirmatory steps if flagged: [Quality review of both tests / repeat testing / none indicated]

Summary: [Longitudinal change within expected limits / Decline exceeds expected—confirm and evaluate]

Recommendations

1. Repeat testing: [Indication and timeframe, if warranted]
2. Further evaluation: [Full PFTs / imaging / specialist referral / symptom evaluation / smoking cessation counseling] (Select as warranted)
3. Workplace actions: [Exposure assessment review / industrial hygiene controls / respirator program review] (Include only if clinically justified)
4. Work status/restrictions: [Specific functional restrictions with documented basis in spirometry findings, symptom status, and confirmation status]
5. Follow-up interval: [Routine schedule / accelerated surveillance—specify rationale]

(Work restriction or removal-from-exposure recommendations must document spirometry findings, symptom status, and whether results were confirmed.)

Worker and Employer Communication

Worker communication: Results discussed: [yes / no]; Date: [Date]; Education provided: [Brief content]

Employer Written Opinion (Limited Disclosure)

• Fitness status: [fit / fit with limitations / not fit pending evaluation]
• Limitations/restrictions: [Specific functional restrictions, if any]
• Follow-up needed: [yes / no]; [Type and timeframe if yes]
• Worker authorization for additional disclosures: [obtained / not obtained]; [Date if obtained]

(Do not include diagnoses or detailed clinical findings unless worker authorization is documented. Content limited to what governing regulation permits.)

Signature

Interpreter: [Name, credentials] — [Signature] — [Date/Time]

Technician attestation: [Name, credentials] — [Statement of test performance and notable issues] — [Date/Time] (Include if different from interpreter)