Respiratory Health Exams
Respiratory health exams, including respirator medical evaluations, respirator fit tests, and other respiratory screening tests, help employers protect workers from dust, fumes, chemicals, and other workplace respiratory hazards. The services needed depend on workplace hazards, job duties, applicable requirements, and whether the employer requires respirator use.
Health Street offers respirator medical evaluations, qualitative and quantitative respirator fit tests, and additional respiratory health screening services. Medical evaluations assess an employee's ability to use a respirator, while fit tests assess the fit of a selected tight-fitting facepiece. Additional exams may be needed under an applicable medical-surveillance requirement or an evaluating clinician's guidance. Explore the services below to learn more.
Types of Respiratory Health Exams
Workplace respiratory hazards can include gases, vapors, dust, mists, fumes, smoke, and airborne pathogens. The presence of a hazard does not automatically mean every employee needs respiratory screening. Employers must evaluate workplace hazards and follow the protection requirements that apply to their work.
When respirators are necessary to protect employees—or the employer requires their use—the applicable respiratory protection program includes medical evaluations and appropriate respirator selection. Employees required to wear tight-fitting respirators also need fit testing.
A respirator medical evaluation determines whether an employee can use the respirator under the expected work conditions. A fit test is separate: it assesses the fit of the selected tight-fitting facepiece on that employee.
The medical evaluation must occur before fit testing or required respirator use. Under federal OSHA's standard, a physician or other licensed health care professional evaluates the employee using OSHA's respiratory questionnaire or an initial medical examination that obtains the same information. Follow-up examinations or testing may be needed based on the evaluation.
Respirator Fit Testing
Employees required to use tight-fitting respirators—because of workplace hazards, an applicable rule, or an employer requirement—must receive appropriate fit testing. Potential exposure to a respiratory hazard alone does not mean every worker needs a fit test.
A respirator fit test assesses the fit of a particular facepiece on an individual. Employers must also select respiratory protection suitable for the hazard: a particulate filter used for dust, for example, does not provide protection against gases or vapors.
There are two fit-testing methods: qualitative and quantitative. The appropriate method depends on the respirator and the level of protection required.
Qualitative respirator fit tests produce a pass/fail result based on the wearer's response to an accepted test agent, such as a sweet or bitter aerosol. They are commonly used for N95s and other half-mask respirators where permitted. For negative-pressure air-purifying respirators, qualitative testing is limited to those requiring a fit factor of 100 or less.
Quantitative respirator fit tests use instruments to numerically measure leakage into the facepiece. Depending on the method, testing uses generated aerosol, ambient aerosol, or controlled negative pressure—not every method counts particles. Quantitative testing can assess half-mask and full-facepiece respirators; the selected protocol must be appropriate for the respirator.
Fit testing is required before initial use, whenever a different make, model, style, or size of facepiece is used, and at least annually. Additional testing is required when a reported or observed physical change could affect fit, such as facial scarring, dental changes, cosmetic surgery, or an obvious change in body weight.
As part of the applicable respiratory protection program, employers must train employees on proper respirator use, limitations, and maintenance. A user seal check is also required each time a tight-fitting respirator is put on; it does not replace fit testing.
Respiratory Health Services and Testing Options
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Chest X-Ray (1 View) $204
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EKG $309
Additional Respiratory Screening
Additional evaluations may be appropriate to establish a baseline or monitor employee health. The need for testing depends on job duties, workplace exposures, applicable medical-surveillance requirements, and the evaluating clinician's guidance. A physically demanding job or the use of a self-contained breathing apparatus (SCBA) does not, by itself, establish that every employee needs every test listed below.
These services may include pulmonary function testing and spirometry, chest X-rays, and electrocardiograms (EKGs). They serve different purposes and are not routine requirements of OSHA's general respirator medical evaluation. However, specific exposure-related standards may require certain tests for covered employees.
Pulmonary Function Testing
Pulmonary function tests evaluate aspects of lung function. Depending on the tests performed, they can assess airflow, lung volumes, or gas transfer. Spirometry is one type of pulmonary function test; it measures how much air a person can breathe out and how quickly. Testing may help establish a baseline, identify abnormalities, or monitor changes over time.
Although spirometry is not routinely required under OSHA's general respiratory protection standard, it is required under some exposure-specific medical-surveillance standards, including the silica and asbestos standards when their coverage criteria are met.
Chest X-Rays
Chest X-rays provide images of structures within the chest and may help clinicians evaluate lung conditions. They may be required under a particular medical-surveillance standard or ordered when medically indicated. Asbestos exposure, hazardous-waste work, or confined-space work does not automatically mean every employee needs a chest X-ray.
A chest X-ray may also be part of the evaluation following a positive TB blood or skin test. The clinician uses it with other information—and additional testing when needed—to distinguish latent TB infection from active TB disease.
EKGs
An electrocardiogram (EKG) records the heart's electrical activity using electrodes attached to the skin. It can identify rhythm abnormalities and provide information useful in evaluating other heart conditions. It is a cardiovascular test, not a lung-function test, and may be included when clinically indicated or required by an applicable medical-evaluation program.
Appropriate testing can support workplace health monitoring, but it does not replace hazard controls, suitable respiratory protection, or employee training. Employers should arrange services based on the requirements and clinical recommendations that apply to their workforce.