Practical considerations for spirometry during the COVID-19 outbreak: Literature review and insights

Abstract

Background As the Coronavirus disease 2019 (COVID-19) is spreading worldwide, countries are dealing with different phases of the pandemic. Lately, scientific evidence has been growing about the measures for reopening respiratory outpatient services during the COVID-19 pandemic. We aim to summarize the key differences and similarities among recommendations by different national and international organizations. Methods We searched on Google and Pubmed for recently published National and International Recommendations/Guidelines/Position Papers from professional organizations and societies, offering a guidance to physicians on how to safely perform pulmonary function testing during COVID-19 pandemic. We also searched for spirometry manufacturers' operational indications. Results Indications on spirometry were released by the Chinese Task force, the American Thoracic Society, the European Respiratory Society, the Thoracic Society of Australia and New Zealand, the Société de Pneumologie de Langue Française, the Spanish Societies (Sociedad Espanola de Neumologia y Cirugia Toracica, Sociedad Espanola de Alergologia e Inmunologia Clinica, Asociacion de Especialistas en Enfermeria del trabajo, Asociacion de Enfermeria Comunitaria), the Sociedade Portuguesa de Pneumologia, the British Thoracic Society/Association for Respiratory Technology & Physiology, the Irish Thoracic Society, the Sociedad Uruguaya de Neumologia, the Italian Thoracic Society and the Italian Respiratory Society, Cleveland Clinic and Nebraska Medical Center. Detailed technical recommendations were found on manufacturers’ websites. We found several similarities across available guidelines for safely resuming pulmonary function services, as well as differences in criteria for selecting eligible patients for which spirometry is deemed essential and advice which was not homogenous on room ventilation precautions. Conclusions This study shows a synthesis of national/international guidelines allowing practicing physicians to adapt and shape the way to organize their outpatient services locally. There is generally good agreement on the importance of limiting pulmonary function testing to selected cases only. However, significant differences concerning the subsets of candidate patients, as well as on the management of adequate room ventilation, were observed.

Asthma and COVID-19: What do we know now

“…Recommendations have been made by many regulatory bodies to place restrictions on pulmonary function testing for the monitoring and diagnosis of respiratory illnesses. 57,58 Pulmonary function testing should be limited to spirometry, oximetry, and arterial blood gases and testing should only be performed on patients if essential for immediate treatment decisions. 58 These restrictions may lead to delayed diagnosis in non-severe asthmatic patients.…”

Sport and exercise participation in time of Covid‐19—A narrative review of medical and health perspective

“…Long‐term performance consequences of COVID‐19 are currently unknown and future studies should provide more data that will definitely put SEM professionals on athletes’ performance map 2 . Cardiopulmonary exercise testing and other functional capacity assessment modalities as aerosol‐generating procedures require special concern in new pandemic conditions 31,32 . Difficulties in providing essential preventive measures during their implementation we might overcome with remote assessment and filed testing.…”

Letter to the Editor Regarding “Pre-HCT Lung Computed Tomography as an Alternative to PFT During the COVID-19 Pandemic”

“…A consistent message in the current guidelines regarding the indications of PFT during the SARS-CoV-2 outbreak is that clinicians must determine whether the benefits of PFT results for clinical decision making outweigh the possible risk of SARS-CoV-2 transmission as a consequence of performing PFT [8] . Some guidelines have specifically advocated allo-HSCT as an ongoing indication for PFT during SARS-CoV-2 pandemic [8] . Moreover, the role of PFT in the transmission of SARS-CoV-2 is uncertain and is suspected to be mostly mediated by the exposure to the spirometer and the surrounding surface, not through aerosols [8] .…”

“…Some guidelines have specifically advocated allo-HSCT as an ongoing indication for PFT during SARS-CoV-2 pandemic [8] . Moreover, the role of PFT in the transmission of SARS-CoV-2 is uncertain and is suspected to be mostly mediated by the exposure to the spirometer and the surrounding surface, not through aerosols [8] . Consequently, we believe that PFT should continue to be included in the pre-allo-HSCT evaluation protocol during the SARS-CoV-2 outbreak whenever possible.…”

“…Of particular importance pertinent to allo-HSCT recipients are proper scheduling of patient visits, universal masking, proper hand hygiene, appropriate cleansing strategies, and adequate room ventilation. It is also recommended that immunocompromised patients should be scheduled for visit at the start of a working day [8] . When an appropriate pulmonary function laboratory is not accessible, we suggest monitoring pulmonary function with handheld spirometry [7] or impulse oscillometry (IOS) [9] , which have an established diagnostic ability to identify post-HSCT BOS.…”