Thijs T Wingelaar1,2,3, Paul Clarijs1, Pieter-Jan Am van Ooij1, Dave Aa Koch1, Rob A van Hulst2. 1. Royal Netherlands Navy Diving Medical Centre, Den Helder, The Netherlands. 2. Department of Anesthesiology, Academic Medical Centre, University of Amsterdam, The Netherlands. 3. Royal Netherlands Navy Diving Medical Centre, Rijkszee en marinehaven, 1780 CA Den Helder, The Netherlands, tt.wingelaar@mindef.nl.
Abstract
INTRODUCTION: Pulmonary function testing (PFT) is an important part of dive medical examinations. Depending on the standard used to assess fitness to dive, different reference sets and fixed cut-off points are used. Reference values are part of an ongoing debate regarding the validity and accuracy related to different age groups, sex and ethnic backgrounds. The Global Lung Initiative (GLI) has provided an all-age reference set which corrects for sex and ethnicity (GLI-2012); this has had substantial impact on pulmonary medicine. METHOD: We present an algorithm that can be used to standardise analysis of PFT in divers using the GLI-2012 reference set. Differences in the analysis of PFT between the ECSC/ERS-1993 and the GLI-2012 reference values are illustrated by means of three case reports. CONCLUSION: Using a valid database of reference values increases accuracy and might prevent additional medical investigations and/or incorrect assessment of fitness to dive. Although our algorithm needs further evaluation to ensure its validity, the preliminary results are promising. Whatever algorithm is used, we urge dive medical physicians to consider using valid reference sets when analysing PFT for assessment of fitness to dive. Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.
INTRODUCTION: Pulmonary function testing (PFT) is an important part of dive medical examinations. Depending on the standard used to assess fitness to dive, different reference sets and fixed cut-off points are used. Reference values are part of an ongoing debate regarding the validity and accuracy related to different age groups, sex and ethnic backgrounds. The Global Lung Initiative (GLI) has provided an all-age reference set which corrects for sex and ethnicity (GLI-2012); this has had substantial impact on pulmonary medicine. METHOD: We present an algorithm that can be used to standardise analysis of PFT in divers using the GLI-2012 reference set. Differences in the analysis of PFT between the ECSC/ERS-1993 and the GLI-2012 reference values are illustrated by means of three case reports. CONCLUSION: Using a valid database of reference values increases accuracy and might prevent additional medical investigations and/or incorrect assessment of fitness to dive. Although our algorithm needs further evaluation to ensure its validity, the preliminary results are promising. Whatever algorithm is used, we urge dive medical physicians to consider using valid reference sets when analysing PFT for assessment of fitness to dive. Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.
Keywords:
Fitness to dive; Flowchart; Global lung initiative; Lung function; Military diving; Standards
Authors: Thijs T Wingelaar; Edwin L Endert; Rigo Hoencamp; Peter-Jan Am van Ooij; Rob A van Hulst Journal: Diving Hyperb Med Date: 2019-12-20 Impact factor: 0.887
Authors: Thijs T Wingelaar; Paul Brinkman; Rigo Hoencamp; Pieter-Jan Am van Ooij; Anke-Hilse Maitland-van der Zee; Markus W Hollmann; Rob A van Hulst Journal: Diving Hyperb Med Date: 2020-03-31 Impact factor: 0.887
Authors: T T Wingelaar; P Brinkman; P J A M van Ooij; R Hoencamp; A H Maitland-van der Zee; M W Hollmann; R A van Hulst Journal: Front Physiol Date: 2019-04-24 Impact factor: 4.566
Authors: Thijs T Wingelaar; Leonie Bakker; Frank J Nap; Pieter-Jan A M van Ooij; Edwin L Endert; Rob A van Hulst Journal: Front Physiol Date: 2021-01-06 Impact factor: 4.566