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

Abstract

The Thoracic Society of Australia and New Zealand (TSANZ) and the Australian and New Zealand Society of Respiratory Science (ANZSRS) commissioned a joint position paper on pulmonary function testing during coronavirus disease 2019 (COVID‐19) in July 2021. A working group was formed via an expression of interest to members of both organizations and commenced work in September 2021. A rapid review of the literature was undertaken, with a ‘best evidence synthesis’ approach taken to answer the research questions formed. This allowed the working group to accept findings of prior relevant reviews or societal document where appropriate. The advice provided is for providers of pulmonary function tests across all settings. The advice is intended to supplement local infection prevention and state, territory or national directives. The working group's key messages reflect a precautionary approach to protect the safety of both healthcare workers (HCWs) and patients in a rapidly changing environment. The decision on strategies employed may vary depending on local transmission and practice environment. The advice is likely to require review as evidence grows and the COVID‐19 pandemic evolves. While this position statement was contextualized specifically to the COVID‐19 pandemic, the working group strongly advocates that any changes to clinical/laboratory practice, made in the interest of optimizing the safety and well‐being of HCWs and patients involved in pulmonary function testing, are carefully considered in light of their potential for ongoing use to reduce transmission of other droplet and/or aerosol borne diseases.

Association between serum uric acid levels and lung function in the NHANES cohort (2007–2012): A cross‐sectional analysis of a diverse American population

“…One such study, 21 which shares similarities with our research, demonstrates an inverse association between the SUA/SCr ratio and FVC and FEV1 in the general American population, although no association was observed with FEV1/FVC. Another study conducted in Japan, 13 involving 2917 participants, reported that the predicted values of FEV1% and FVC% in females were inversely associated with UA. A final study from Korea 22 was conducted, a retrospective cohort analysis comprising 19 237 individuals who underwent at least three health screenings and were followed up for over 5 years.…”

“…One such study, 21 which shares similarities with our research, demonstrates an inverse association between the SUA/SCr ratio and FVC and FEV1 in the general American population, although no association was observed with FEV1/FVC. Another study conducted in Japan, 13 sue detriment and the impairment of alveoli and airways. [25][26][27][28][29] UA positively correlated with inflammatory markers, including TNFα, C-reactive protein, and IL-6.…”

“…In addition to spirometry, other tests for lung function may also be conducted, such as lung volumes, diffusion capacity across the lung for carbon monoxide (DLCO), respiratory muscle strength assessments, oscillometry, bronchial provocation, and exercise physiology tests. 13 However, complex interpretations exist regarding UA's potential benefits or harms to lung function. Specifically, in the broader population of Japan, the levels of UA in individuals with lung or airflow restrictions tend to be higher than those without such restrictions.…”

“…This test offers crucial information to clinicians and is employed alongside physical examinations, symptoms, and medical history to establish a diagnosis. In addition to spirometry, other tests for lung function may also be conducted, such as lung volumes, diffusion capacity across the lung for carbon monoxide (DLCO), respiratory muscle strength assessments, oscillometry, bronchial provocation, and exercise physiology tests 13 …”

Undiagnosed and ‘overdiagnosed’ COPD using postbronchodilator spirometry in primary healthcare settings: a systematic review and meta-analysis

“…During the pandemic, the number of primary care spirometry tests in particular fell dramatically from prolonged disruptions that has now led to the deskilling of staff with probable loss of confidence in performing spirometry. This has only been partially reversed in the ‘living-with-COVID-19’ era78 due to ongoing concerns about the potential spread of SARS-CoV-2 virus to healthcare workers and patients through performing spirometry which can generate aerosol droplets, especially by inducing coughing 79 80…”