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Spirometry during COVID-19


When can we safely resume spirometry and exhaled nitric oxide tests in the office during the pandemic?


Unfortunately, there is not a clear answer to your question. As things begin to open up there will be pressure to resume spirometry and ENO, but these will all require the use of full PPE (face mask, N95 respirator, gown, and gloves). With COVID-19, PPE use will likely be the new normal. PPE is required for studies that provoke aerosolization, such as spirometry, ENO, PEFM, Rhinolaryngoscopy and nasal swabs. Currently, these studies have been put on hold primarily to conserve PPE for front line (ED) and direct inpatient care. As PPE becomes more available, spirometry and ENO could then be resumed in outpatient offices — provided full PPE is used, as per the CDC guidelines.

AAAAI along with ATS and CDC continually update recommendations. I have included statements from the AAAAI and ATS below. I have also included links for you to use to follow along with updates.

An Update on COVID-19 for the Practicing Allergist/immunologist, April 16, 2020. (1)

Nebulizer therapy, spirometry, sputum induction and rhinoscopy—all considered high-risk exposure. The CDC recommends the use of appropriate PPE for any aerosol generating procedures, which includes testing patients (nasal swabs), the use of nebulizers, peak flow meters, spirometry. Transmission may occur from asymptomatic individuals.

American Thoracic Society Advice Regarding COVID-19 For Pulmonary Function Laboratories. (2)

Concern has been raised that pulmonary function testing could represent a potential avenue for COVID-19 transmission due to the congregation of patients with lung disease and because of the potential for coughing and droplet formation surrounding pulmonary function testing procedures. We recognize that most patients are screened for symptoms and travel before entry into our health care systems, but it is more difficult to screen and assess pulmonary patients who are more likely to have respiratory symptoms unrelated to COVID-19. There remain many unknowns about the possibility of transmission in this setting and the data are in evolution; however, the risks of transmission may be significant, and likely vary based on the prevalence of the virus in the community and the age, severity of lung disease and presence of immunosuppression.

We recommend that pulmonary function testing be limited to tests that are only essential for immediate treatment decisions, that the type of pulmonary function testing be limited to the most essential tests when possible, and that measures to protect both the staff and individuals being tested should be put in place. Protective measures include personal protective equipment (PPE) that limits aerosolized droplet acquisition for staff and enhanced cleaning of the testing space such as wiping down surfaces with appropriate cleaners. Use of PPE should be considered in discussions with your infection control team.

Decisions regarding the conduct of pulmonary function tests need to balance the potential risks against the need for assessment of lung function to make treatment decisions. We realize that this is an evolving situation and that the risk/benefit ratio will also continue to change over time

1) An Update on COVID-19 for the Practicing Allergist/immunologist, April 16, 2020

2) Advice Regarding COVID-19 For Pulmonary Function Laboratories

I hope you find this helpful.

Respectfully submitted
Jeffrey G Demain, MD, FAAAAI