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ajim22282-sm-0001-SupFig-S1.docx296KFIGURE S1. SPIROLA screenshot plots for longitudinal changes in (A) forced expiratory volume in one second (FEV1), (B) forced vital capacity (FVC), and (C) percent predicted FEV1 and FVC, and FEV1/FVC ratio (expressed as percent) for a flavoring manufacturing employee. A, B: Plotted are the regression lines (Regr. line) for the serial measurements, the 5th and 0.1 percentile lower limits of normal (LLN) calculated from age, height, and gender, the American College of Occupational and Environmental Medicine (ACOEM) criterion for excessive decline of 15% and 30 ml/year for FEV1, and the relative lower limit of decline (LLDr) of 12.4% and 30 ml/year) for the quality of spirometry (5% intra-individual variation). This employee had excessive falls in FEV1 and FVC despite having normal spirometry values above the LLN line. C: Plotted are the FEV1 and FVC percent predicted measurements, the FEV1/FVC ratio, and 100th and 70th percentile lines. These show that the employee initially had FEV1 and FVC values well above average (both 120% predicted) that fell to slightly below average (96% and 94% predicted, respectively) on last measurement. The FEV1/FVC ratio remained normal and stable, consistent with a pattern that might result in restriction if FVC eventually fell below the lower limit of normal. ACOEM, American College of Occupational and Environmental Medicine; FEV1, Forced expiratory volume in 1 s; FVC, Forced Vital Capacity; FEV1/FVC, Ratio of forced expiratory volume in 1 s to forced vital capacity, expressed as percent; Regr. line, Regression line; LLN, lower limit of normal (5th percentile), 0.1th percentile; LLDR, Relative lower limit of decline.

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