International consensus on lung function testing during COVID-19 pandemic and beyond

COVID-19 has negatively affected the delivery of respiratory diagnostic services across the world due to the potential risk of disease transmission during lung function testing. Community prevalence, reoccurrence of COVID-19 surges, and the emergence of different variants of the SARS-CoV-2 virus have impeded attempts to restore services. Finding consensus on how to deliver safe lung function services for both patients attending and for staff performing the tests are of paramount importance.This international statement presents the consensus opinion of 23 experts in the field of lung function and respiratory physiology balanced with evidence from the reviewed literature. It describes a robust roadmap for restoration and continuity of lung function testing services during the COVID-19 pandemic and beyond.Important strategies presented in this consensus statement relate to the patient journey when attending for lung function tests. We discuss appointment preparation, operational and environmental issues, testing room requirements including mitigation strategies for transmission risk, requirement for improved ventilation, maintaining physical distance, and use of personal protection equipment. We also provide consensus opinion on precautions relating to specific tests, filters, management of special patient groups, and alternative options to testing in hospitals.The pandemic has highlighted how vulnerable lung function services are and forces us to re-think how long term mitigation strategies can protect our services during this and any possible future pandemic. This statement aspires to address the safety concerns that exist and provide strategies to make lung function tests and the testing environment safer when tests are required.

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Risk and mitigation of aerosolisation from lung function testing: results from the AERATOR study

10.1101/2021.03.06.21253033 ◽

2021 ◽

Author(s):

S Sheikh ◽

F Hamilton ◽

GW Nava ◽

F Gregson ◽

D Arnold ◽

...

Keyword(s):

Lung Function ◽

Healthy Volunteers ◽

Peak Flow ◽

Mitigation Strategies ◽

Lung Function Testing ◽

Voluntary Cough ◽

Aerosol Emission ◽

Monitoring Tools ◽

Particle Sizer ◽

Function Testing

IntroductionLung function tests are fundamental diagnostic and monitoring tools for patients with respiratory symptoms. There is significant uncertainty around whether potentially infectious aerosol is produced during different lung function testing modalities; and limited data on possible mitigation strategies to reduce risk to staff and limit fallow time.MethodsHealthy volunteers were recruited in an ultraclean, laminar flow theatre and had standardised spirometry as per ERS/ATS guidance, as well as peak flow measurement and FENO assessment of airway inflammation. Aerosol emission was sampled minimum once each second using both an Aerodynamic Particle Sizer (APS) and Optical Particle Sizer (OPS), and compared to breathing, speaking and coughing. Mitigation strategies such as a peak flow viral filter and a CPET facemask (to mitigate induced coughing) were tested.Results33 healthy volunteers were recruited. Aerosol emission was highest in cough (1.61 particles/cm3/sample), followed by unfiltered peak flow (0.76 particles/cm3/sample). Filtered spirometry produced lower peak aerosol emission (0.11 particles/ cm3/sample) than that of a voluntary cough, and addition of a viral filter to the mouthpiece reduced peak flow aerosol emission to similar levels. The filter made little difference to recorded FEV peak flow values. Peak aerosol FENO measurement produced negligible aerosol. Reusable CPET masks with filter reduced aerosol emission when breathing, speaking, and coughing significantly.ConclusionsCompared to voluntary coughing, all lung function testing produced fewer aerosol particles. Filtered spirometry produces lower peak aerosol emission than peak voluntary coughing, and should not be deemed an aerosol generating procedure. The use of viral filters reduces aerosol emission in peak flow by > 10 times, and has little impact on recorded peak flow values. CPET masks are a useful option to reduce aerosol emission from induced coughing while performing spirometry.

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Does training respiratory physicians in clinical respiratory physiology and interpretation of pulmonary function tests improve core knowledge?

Thorax ◽

10.1136/thoraxjnl-2016-209136 ◽

2017 ◽

Vol 73 (1) ◽

pp. 78-81 ◽

Cited By ~ 3

Author(s):

M Patout ◽

L Sesé ◽

T Gille ◽

B Coiffard ◽

S Korzeniewski ◽

...

Keyword(s):

European Union ◽

Lung Function ◽

Pulmonary Function ◽

Pulmonary Function Tests ◽

Respiratory Physiology ◽

Lung Function Tests ◽

Core Knowledge ◽

The European Union ◽

Diagnostic Skills ◽

Function Tests

Lung function tests have a major role in respiratory medicine. Training in lung function tests is variable within the European Union. In this study, we have shown that an internship in a lung function tests laboratory significantly improved the technical and diagnostic skills of French respiratory trainees.

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Are aerosols generated during lung function testing in patients and healthy volunteers? Results from the AERATOR study

Thorax ◽

10.1136/thoraxjnl-2021-217671 ◽

2021 ◽

pp. thoraxjnl-2021-217671

Author(s):

Sadiyah Sheikh ◽

Fergus W Hamilton ◽

George W Nava ◽

Florence K A Gregson ◽

David T Arnold ◽

...

Keyword(s):

Lung Function ◽

Healthy Volunteers ◽

Peak Flow ◽

Number Concentration ◽

Mitigation Strategies ◽

Lung Function Testing ◽

Aerosol Emission ◽

Aerosol Number Concentration ◽

Particle Sizer ◽

Function Testing

Pulmonary function tests are fundamental to the diagnosis and monitoring of respiratory diseases. There is uncertainty around whether potentially infectious aerosols are produced during testing and there are limited data on mitigation strategies to reduce risk to staff. Healthy volunteers and patients with lung disease underwent standardised spirometry, peak flow and FENO assessments. Aerosol number concentration was sampled using an aerodynamic particle sizer and an optical particle sizer. Measured aerosol concentrations were compared with breathing, speaking and voluntary coughing. Mitigation strategies included a standard viral filter and a full-face mask normally used for exercise testing (to mitigate induced coughing). 147 measures were collected from 33 healthy volunteers and 10 patients with lung disease. The aerosol number concentration was highest in coughs (1.45–1.61 particles/cm3), followed by unfiltered peak flow (0.37–0.76 particles/cm3). Addition of a viral filter to peak flow reduced aerosol emission by a factor of 10 without affecting the results. On average, coughs produced 22 times more aerosols than standard spirometry (with filter) in patients and 56 times more aerosols in healthy volunteers. FENO measurement produced negligible aerosols. Cardiopulmonary exercise test (CPET) masks reduced aerosol emission when breathing, speaking and coughing significantly. Lung function testing produces less aerosols than voluntary coughing. CPET masks may be used to reduce aerosol emission from induced coughing. Standard viral filters are sufficiently effective to allow guidelines to remove lung function testing from the list of aerosol-generating procedures.

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A Review on Functions of Rakt Dhatu and Prana Vayu to Establish Lung Function Capacity

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol03-i01/13 ◽

2018 ◽

Vol 3 (01) ◽

Author(s):

Dr. Vishal Shamrao Patil ◽

Dr. (Mrs.) Manisha V. Bhalsing

Keyword(s):

Lung Function ◽

Functional Status ◽

Respiratory System ◽

Lung Function Tests ◽

Lung Volumes ◽

Happy Life ◽

Pathological Conditions ◽

Function Tests ◽

Forced Breathing

Lung function tests are useful in assessing the functional status of Respiratory system in both in physiological as well as pathological conditions. These are based on the measurement of volume of air breathed in and out in quite breathing & forced breathing. Air in lungs is classified in to two divisions’ lung volumes & lung capacities. Lung Capacities are the combination of two or more lung volumes. The concept of Rakt Dhatu & Vayu is important in case of respiration because Charaka says that pure blood provides the person with strength, luster & happy life because vital breath follows blood. It represents mechanism of oxygenated & deoxygenated blood & its relation with functioning capacity of Lungs. So In this article attempt has been made to review concepts regarding functions of Rakt Dhatu & Vayu to Establish Lung Function Capacity.

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