Medical clearance for respirator use: Sensitivity and specificity of a questionnaire

Background OSHA regulations require that workers receive medical clearance prior to respirator use, and recently, a detailed questionnaire has been pr ovided to assist with this purpose. However; there are limited published da ta on the sensitivity and specificity of self-administered questionnaires f or identifying individuals who may safely wear a respirator. Methods We tested 474 consecutive workers at a Department of Energy complex . After completing the self-administered questionnaire, all workers receive d a standardized physician evaluation including interview, physical examina tion, and spirometry. The outcomes of the questionnaire assessment were com pared to the outcomes of physician evaluation. Results Data for analysis were available from 413 of workers (87%). All wor kers received medical clearance; only 10 workers (2.4 %) received work rest rictions. The questionnaire demonstrated 100% sensitivity in identifying wo rkers who required work restrictions, but had specificity of only 19%. Comp ared to physician evaluation, the questionnaire had modest sensitivity to t he detection of chronic medical conditions. Conclusions These data suggest that the rates of medical clearance for resp irator use are very high, and that a self-administered questionnaire may be appropriate for medical clearance in certain settings. It is recommended t hat the policy of routine physician evaluation and spirometry for respirato r clearance be re-examined. Am. J. Ind. Med. 35:395-400, 1999. (C) 1999 Wil ey-Liss, Inc.