Functional Respiratory Evaluation in the COVID-19 Era: The Role of Pulmonary Function Test Laboratories

Abstract

The pandemic character of coronavirus disease-19 (COVID-19) requires strategy changes designed to guarantee the safety of patients and health-care professionals. We are greatly concerned by the limitations in the operation of pulmonary function test (PFT) laboratories, since there is a high risk of disease progression in patients with chronic pulmonary diseases, and we are now faced by the influx of a new group of individuals in the recovery phase of post-COVID-19-syndrome that requires evaluation and follow-up of their respiratory function. To reestablish the operation of PFT laboratories limiting the risk of cross-contamination, we herein present the consensus reached by a group of experts in respiratory physiology, most of whom work in PFT laboratories in several Latin American countries, on the applicable recommendations for severe acute respiratory syndrome coronavirus 2 pneumonia survivors when undergoing PFT. We present the safety and hygiene measures that must be adopted in laboratories or centers where PFT is conducted in adults and/or children. These recommendations answer the following questions: which PFT is most recommended in subjects that have recovered from COVID-19; what quality control and safety measures should PFT laboratories implement during this pandemic? And how should we approach non-COVID-19 patients requiring PFT?.

Pediatric Pulmonary Function Testing in COVID-19 Pandemic and Beyond. A Position Statement From the Hellenic Pediatric Respiratory Society

“…During the first phases of the pandemic, PFTs were universally suspended to control the spread of the disease (5). However, as the pandemic unfolded, ERS (15), ATS (16) and several national respiratory societies (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) have issued detailed recommendations (Table 2), of which the main points could be summarized as follows:…”

“…• The value of pulmonary function testing is reiterated together with the need to prevent infection spread to patients and staff (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). • It is universally recommended to avoid pulmonary function testing in patients infected with COVID-19 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). asthma that requires treatment modification, patients with chronic lung diseases that require therapeutic interventions, patients with interstitial or restrictive lung disorders and for pre-operative evaluation (15-21, 26-28, 30).…”

“…• Spirometry is the only test that can be performed even when the epidemiologic load is moderate, provided that stringent selection criteria are applied (17-32). • In any phase of the pandemic, PFTs are carried out with special protective measures for all involved parties (laboratory staff, patients, accompanying family members) (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32).…”

“…Most of these recommendations are expert group consensuses (15,17,(19)(20)(21)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). To date, pediatric-specific guidelines have been issued by the ERS/ATS (30), a consortium of pediatric pulmonology experts from India (31), and the Italian Pediatric Respiratory Society (32).…”

Improvement in Walking Distance Lags Raise in Lung Function in Post-COVID Patients

“…All PFT lab staff wore personal protective equipment; and each patient used disposable virus and bacterial filters. 16 …”