Recommendations concerning medical examinations

• Pages: 67-69

D. Recommendations concerning medical examinations

1. General

1.1. The recommendations of this appendix are intended as medical guide-lines.

Occupational physicians may wish to supplement these provisions to meet local needs and to

assist in proper evaluation of individual cases.

1.2. The health personnel responsible for the medical examination of workers shall

have free access to their workplaces and to the data on monitoring of the level and duration of

exposure to asbestos dust. When necessary, they may require additional measurements of

exposure.

2. Structure of the medical examination

2.1. The pre-assignment medical examination of workers whose work is likely to

involve them in exposure to asbestos dust should include:

(a) a case history which includes the occupational history of the worker with an emphasis on

the respiratory system, previous occupational exposures and smoking history;1

(b) a general physical examination, with an emphasis on the respiratory system;

(c) a full-sized postero-anterior chest radiograph to be obtained and interpreted using the

most recent ILO guide-lines;2

(d) spirometry, in order to obtain representative forced vital capacity (FVC) measurements

and forced expiratory volume in one second (FEV1);

(e) additional tests as necessary for diagnostic purposes, particularly in high-risk groups of

workers.

2.2. The periodic medical examination for asbestos dust exposure should include:

(a) a brief medical and occupational history including smoking habits;

(b) a physical examination, with an emphasis on the respiratory evaluation;

(c) a full-sized postero-anterior chest radiograph to be obtained and interpreted using the

most recent ILO guide-lines;3

(d) spirometry to obtain a representative FVC and FEV1;

(e) additional tests as necessary for diagnostic purposes, particularly in high-risk groups of

workers.

2.3. Medical examinations following sickness will depend largely upon the nature of

the sickness. Should the sickness be thought possible to be work-related, further documentation

is indicated.

1 The ILO publication entitled Respiratory Function Tests in Pneumoconioses, Occupational Safety and

Health Series, No. 6 (Geneva, 1966), pp. 141-144, provides a copy of the MRC (United Kingdom, Medical Research

Council) Short Questionnaire on Respiratory Symptoms. This remains a useful questionnaire with which to assess

respiratory symptoms, occupational history and smoking history.

2 Guidelines for the use of ILO international classification of radiographs of pneumoconioses,

Occupational Safety and Health Series, No. 22 (Revised edition, 1980), (Geneva, Third impression 1983), provides a

detailed description of the international classification, standard films, guidance notes on radiographic equipment and

technology, and a suggested reading sheet.

3 See note 2, p. 105.

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