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

Abstract

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.

Wearing a surgical mask: Effects on gas exchange and hemodynamic responses during maximal exercise

“…Professional athletes were also not included in the study. Each participant was interviewed regarding any COVID‐19 symptoms according to the European Respiratory Society recommendations (McGowan et al, 2020).…”

“…Cardiopulmonary Exercise Test (CPET) was performed taking into consideration all precautions of the European Respiratory Society (ERS) current exercise test guidelines published for the COVID‐19 pandemic (McGowan et al, 2020). According to ERS recommendations, the test should always be performed with a high specification disposable bacterial and viral filter selected in our research (Antibacterial Filter Round Mouthpiece).…”

Telemedicine and virtual respiratory care in the era of COVID-19

“…[68,69] Anticipated benefits compared to telephone consultations are the ability to pick up non-verbal clues, avoid misunderstandings and improve rapport. [70] More specifically, in the respiratory context there was already interest in the potential to observe and demonstrate inhaler technique, [70] improve adherence to tuberculosis therapy with remote directly observed therapy, [71] deliver breathlessness training for COPD, [72] share completion of an asthma action plan, [73] undertake remote spirometry, [74] provide supportive and palliative care in cancer, [75] and follow-up OSAHS. [59] Early exploratory work highlighted that the perceived benefits of having a visual component were tempered by practical problems with the technical infrastructure as either the patient or the clinician had inadequate bandwidth, or an unstable connectionand sometimes just a lack of basic equipment such as a webcam.…”

Pulmonary function testing during SARS‐CoV‐2: An ANZSRS/TSANZ position statement

“…Elimination A CDC summary 49 and recent reviews 50,51 report that while persistent detectable SARS-CoV-2 RNA on PCR testing is seen in some patients who have recovered from COVID-19 infection, replication-competent virus has rarely been recovered. Furthermore, infectivity is unlikely after 10 days from diagnosis in mild to moderate infection and after 20 days in those with severe infection and/or an immunocompromised state.…”

“…Clearance criteria for those with severe illness, and, or persistent symptoms, as well as those who are immunocompromised have been variably defined as occurring up to 20 days after symptom onset (provided that fever has resolved and symptoms have improved). 49,[55][56][57] These definitions have evolved in different jurisdictions over time. The shorter duration of clearance after 7 days (and ongoing review of isolation requirements for household contacts) has been increasingly suggested and adopted at least partially for pragmatic reasons as COVID-19 infections move towards a recurrent outbreak phase.…”