Rethinking Respiratory Function Test Lab in the Era of COVID-19 : considerations about the “today” and the “day after”

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Salient features:

This article focuses on:

  • Protocol for the use of Pulmonary Function Test
  • Conclusion

Detailed summary:

Protocol for the usee of  Pulmonary Function Test

  • The Members of Proficiency Standards for Pulmonary Function Testing Committee of the American Thoracic Society recommended that “PFT be limited to tests that are only essential for immediate treatment decisions” and that “personal protective equipment (PPE) for healthcare workers should be discussed with local infection control team”.
  • Highly efficient anti-bacterial/anti-viral filters are widely adopted as stated by ERS/ATS guidelines, assuring body-plethysmograph disinfection and air quality of the lab between patients is mandatory.
  • Common indications for pulmonary function testing include: evaluation of respiratory complaints, such as cough and dyspnea; assessment and monitoring of disease severity and progression; monitoring for drug toxicity and efficacy; pre-operative assessment ; evaluation of the effects of 17 occupational or hazardous exposures; and participation in epidemiologic surveys.
  • PFT is needed for the diagnosis and management of a significant group of respiratory diseases and is a key element of the “future risk” assessment of asthma.
  • The measurement of lung volumes is an essential part of severe asthma evaluation as the severity of asthma appears to be linked to enhanced air trapping rather than the level of airflow obstruction.
  • PFT is used and recommended for the assessment and management of interstitial lung diseases, such as Idiopathic Pulmonary Fibrosis particular, the pulmonary function indices, as FVC and CO diffusion capacity, are part of the flowchart for pirfenidone or 26 nintedanib prescription.
  • Until highly effective drug treatments or vaccines are available, we cannot assume that PFT can be 30 done without adequate PPE for healthcare personnel.
  • Respiratory Function Test Labs should be considered a highly specialized Laboratory Units (LU) directed by a Chief with full responsibility for the safety of healthcare personal and quality control, located in dedicated areas ensuring enough space and ventilation for subjects attending respiratory function measurements.
  • The use of air purification or ultraviolet/ozone decontamination systems should be applied according to the indications of the hospital or company management staff for rooms where aerosol generating procedures are carried out..
  • Time between each procedure should be enough to avoid aggregation and allow disinfection of the exterior surfaces of the spirometer and air quality generation.
  • More dedicated rooms with more dedicated instruments will be the only solution for more tests simultaneously.
  • It also seems conceivable that we should think about a shift from the “classic” bronchoprovocation test to metacholine, which generates high amounts of aerosol, to other more feasible tests


  • PFT procedures have been associated with an increasing risk of COVID-19 transmission among patients and medical teams.
  • Effective prevention and control strategies must be urgently implemented to prevent nosocomial infection diffusion.
  • This recommendation is intended to be followed by healthcare workers of a PFT laboratory when COVID-19 is in an epidemic phase.
  • Based on the features of PFT, precaution principles and strategies must be developed taking into account three specific aspects: operating procedure, environment and equipment.
  • Indications of PFT should be followed strictly.
  • Suspend PFT for the confirmed or suspected cases of COVID-19 during the contagious phase, and postpone the test for other patients if it is not imperative.
  • Medical personnel should mandatorily adhere to the standard precautional protocols and the patients should be isolated in a separate area for testing.
  • Disposable inline filters must be used during PFT and cleaning/disinfection procedures for environment and equipment in PFT laboratory should be consistently performed.
  • Impulse Oscillometry (IOS) and nitric oxide (FeNO) measurement, both not requiring forced maneuvers and reducing the potential for coughing and droplet formation, could represent in the future a possible first functional approach to diagnosis and assessment of asthmatic patients.

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