Calibration Myths in the 2019 American Thoracic Society/European Respiratory Society Spirometry Technical Standards

This document provides an update to the European Respiratory Society (ERS)/American Thoracic Society (ATS) technical standards for single-breath carbon monoxide uptake in the lung that was last updated in 2005. Although both DLCO (diffusing capacity) and TLCO (transfer factor) are valid terms to describe the uptake of carbon monoxide in the lung, the term DLCO is used in this document. A joint taskforce appointed by the ERS and ATS reviewed the recent literature on the measurement of DLCO and surveyed the current technical capabilities of instrumentation being manufactured around the world. The recommendations in this document represent the consensus of the taskforce members in regard to the evidence available for various aspects of DLCO measurement. Furthermore, it reflects the expert opinion of the taskforce members on areas in which peer-reviewed evidence was either not available or was incomplete. The major changes in these technical standards relate to DLCO measurement with systems using rapidly responding gas analysers for carbon monoxide and the tracer gas, which are now the most common type of DLCO instrumentation being manufactured. Technical improvements and the increased capability afforded by these new systems permit enhanced measurement of DLCO and the opportunity to include other optional measures of lung function.

Download Full-text

Executive Summary: 2017 ERS/ATS standards for single-breath carbon monoxide uptake in the lung

European Respiratory Journal ◽

10.1183/13993003.e0016-2016 ◽

2017 ◽

Vol 49 (1) ◽

pp. 16E0016 ◽

Cited By ~ 9

Author(s):

Brian L. Graham ◽

Vito Brusasco ◽

Felip Burgos ◽

Brendan G. Cooper ◽

Robert Jensen ◽

...

Keyword(s):

Carbon Monoxide ◽

Lung Function ◽

American Thoracic Society ◽

Common Type ◽

Tracer Gas ◽

European Respiratory Society ◽

Technical Standards ◽

Executive Summary ◽

Link Type ◽

Single Breath

This document summarises an update to the European Respiratory Society (ERS)/American Thoracic Society (ATS) technical standards for single-breath carbon monoxide uptake in the lung that was last updated in 2005. The full standards are also available online as https://doi.org/10.1183/13993003.00016-2016. The major changes in these technical standards relate to DLCO measurement with systems using rapidly responding gas analysers for carbon monoxide and the tracer gas, which are now the most common type of DLCO instrumentation being manufactured. Technical improvements and the increased capability afforded by these new systems permit enhanced measurement of DLCO and the opportunity to include other optional measures of lung function.

Download Full-text

Standardization of spirometry: what’s new in 2019 update (Part 2)

Medical alphabet ◽

10.33667/2078-5631-2020-14-10-18 ◽

2020 ◽

Vol 1 (14) ◽

pp. 10-18

Author(s):

L. D. Kiryukhina ◽

P. V. Struchkov

Keyword(s):

Task Force ◽

Test Session ◽

American Thoracic Society ◽

European Respiratory Society ◽

Technical Standards ◽

Joint Task ◽

Joint Task Force ◽

International Joint ◽

New Research

Improvements in equipment, new research studies and enhanced quality assurance approaches have led to the need to update the 2005 technical standards for spirometry. The article presents the main updates, developed by an international joint task force by the American Thoracic Society and the European Respiratory Society in 2019. The characteristics of acceptability, usability, and repeatability, criteria grading the quality of the test session, the choice of main reported values are described.

Download Full-text

Measurement of Single-Breath Diffusing Capacity of the Lungs for Carbon Monoxide: new standards of European Respiratory Society and American Thoracic Society (рart 2)

Russian Pulmonology ◽

10.18093/0869-0189-2019-29-3-269-291 ◽

2019 ◽

Vol 29 (3) ◽

pp. 269-291

Author(s):

Article Editorial

Keyword(s):

Carbon Monoxide ◽

Expert Opinion ◽

Transfer Factor ◽

American Thoracic Society ◽

Diffusing Capacity ◽

Capacity Measurement ◽

European Respiratory Society ◽

Technical Standards ◽

Single Breath ◽

Published Evidence

This document is updated technical standards of European Respiratory Society (ERS) and American Thoracic Society (ATS) for single-breath carbon monoxide diffusing capacity measurement. The previous version of this document was published in 2005. Both terms used to describe the uptake of carbon monoxide in the lungs, DLCO (diffusing capacity) and TLCO (transfer factor), are equally valid, but the term DLCO is used in this document. The document was developed by joint ATS/ERS taskforce and was based on a survey of published evidence. Expert opinion was used for issues for which evidence was not available or was insufficient. Principal changes in the technical standards are related to new systems with rapidly responding gas analyzers for carbon monoxide. Additional materials are available at erj.ersjournals.com.Adopted from: Graham B.L., Brusasco V., Burgos F., Cooper B.G., Jensen R., Kendrick A., MacIntyre N.R., Thompson B.R., Wanger J. 2017 ERS/ATS standards for single-breath carbon monoxide uptake in the lung. Eur. Respir. J. 2017; 49 (1): pii: 1600016. DOI: 10.1183/13993003.00016-2016.

Download Full-text

Measurement of Single-Breath Diffusing Capacity of the Lungs for Carbon Monoxide: new standards of European Respiratory Society and American Thoracic Society (рart 1)

Russian Pulmonology ◽

10.18093/0869-0189-2019-29-2-149-158 ◽

2019 ◽

Vol 29 (2) ◽

pp. 149-158

Author(s):

Article Editorial

Keyword(s):

Carbon Monoxide ◽

Expert Opinion ◽

Transfer Factor ◽

American Thoracic Society ◽

Diffusing Capacity ◽

Capacity Measurement ◽

European Respiratory Society ◽

Technical Standards ◽

Single Breath ◽

Published Evidence

This document is updated technical standards of European Respiratory Society (ERS) and American Thoracic Society (ATS) for single-breath carbon monoxide diffusing capacity measurement. The previous version of this document was published in 2005. Both terms used to describe the uptake of carbon monoxide in the lungs, DLCO (diffusing capacity) and TLCO (transfer factor), are equally valid, but the term DLCO is used in this document. The document was developed by joint ATS/ERS taskforce and was based on a survey of published evidence. Expert opinion was used for issues for which evidence was not available or was insufficient. Principal changes in the technical standards are related to new systems with rapidly responding gas analyzers for carbon monoxide. Additional materials are available at erj.ersjournals.com.

Download Full-text

ERS/ATS technical standard on interpretive strategies for routine lung function tests

European Respiratory Journal ◽

10.1183/13993003.01499-2021 ◽

2021 ◽

pp. 2101499

Author(s):

Sanja Stanojevic ◽

David A. Kaminsky ◽

Martin Miller ◽

Bruce Thompson ◽

Andrea Aliverti ◽

...

Keyword(s):

Lung Function ◽

Pulmonary Function ◽

Pulmonary Function Tests ◽

American Thoracic Society ◽

International Standards ◽

Healthy Population ◽

European Respiratory Society ◽

Technical Standards ◽

Function Tests ◽

Published Evidence

BackgroundAppropriate interpretation of pulmonary function tests (PFTs) involves the classification of observed values as within/outside the normal range based on a reference population of healthy individuals, integrating knowledge of physiologic determinants of test results into functional classifications, and integrating patterns with other clinical data to estimate prognosis. In 2005, the American Thoracic Society and the European Respiratory Society jointly adopted technical standards for the interpretation of PFTs. We aimed to update the 2005 recommendations and incorporate evidence from recent literature to establish new standard for PFT interpretation.MethodsThis technical standards document was developed by an international joint task force, appointed by the European Respiratory Society and the American Thoracic Society with multidisciplinary expertise in conducting and interpreting pulmonary function tests, and developing international standards. A comprehensive literature review was conducted, and published evidence was reviewed.ResultsRecommendations for the choice of reference equations and limits of normal of the healthy population to identify individuals with unusually low or high results, respectively are discussed. Interpretation strategies for bronchodilator responsiveness testing, limits of natural changes over time and severity are also updated. Interpretation of measurements made by spirometry, lung volumes and gas transfer are described as they relate to underlying pathophysiology with updated classification protocols of common impairments.ConclusionsPFTs interpretation must be complemented with clinical expertise and consider the inherent biological variability of the test and the uncertainty of the test result to ensure appropriate interpretation of an individual's lung function measurements.

Download Full-text

A European Respiratory Society technical standard: exhaled biomarkers in lung disease

European Respiratory Journal ◽

10.1183/13993003.00965-2016 ◽

2017 ◽

Vol 49 (4) ◽

pp. 1600965 ◽

Cited By ~ 213

Author(s):

Ildiko Horváth ◽

Peter J. Barnes ◽

Stelios Loukides ◽

Peter J. Sterk ◽

Marieann Högman ◽

...

Keyword(s):

Task Force ◽

Exhaled Breath Condensate ◽

Research Priorities ◽

Disease Diagnosis ◽

Future Research ◽

Exhaled Breath ◽

Sample Collection ◽

European Respiratory Society ◽

Technical Standards ◽

Breath Tests

Breath tests cover the fraction of nitric oxide in expired gas (FENO), volatile organic compounds (VOCs), variables in exhaled breath condensate (EBC) and other measurements. For EBC and for FENO, official recommendations for standardised procedures are more than 10 years old and there is none for exhaled VOCs and particles. The aim of this document is to provide technical standards and recommendations for sample collection and analytic approaches and to highlight future research priorities in the field. For EBC and FENO, new developments and advances in technology have been evaluated in the current document. This report is not intended to provide clinical guidance on disease diagnosis and management.Clinicians and researchers with expertise in exhaled biomarkers were invited to participate. Published studies regarding methodology of breath tests were selected, discussed and evaluated in a consensus-based manner by the Task Force members.Recommendations for standardisation of sampling, analysing and reporting of data and suggestions for research to cover gaps in the evidence have been created and summarised.Application of breath biomarker measurement in a standardised manner will provide comparable results, thereby facilitating the potential use of these biomarkers in clinical practice.

Download Full-text