ERS International Congress, Madrid, 2019: highlights from the Allied Respiratory Professionals' Assembly

Ana Oliveira; Matthew Rutter; Juan Carlos Quijano-Campos; Beatriz Herrero-Cortina; Marco Clari; Aoife O'Rourke; Aisling McGowan; Chris Burtin; Andreja Sajnic; Jana De Brandt

doi:10.1183/23120541.00034-2020

Tables

TABLE 1

Updated areas of the American Thoracic Society/European Respiratory Society technical standard on spirometry

Patients	Equipment	Operator	Procedure	Analysis	Quality assessment
Patient safety Relative contraindication Activities to avoid Medication withhold times Within-test feedback for achieving full exhalation	Equipment complies with ISO standard Error tolerances of ±2.5% Measurement of inspiration and expiration Revised calibration verification checks Introduced warning messages	Required to complete competency assessments Operators should have adequate training to perform spirometry	Tidal breathing prior to rapid inspiration to maximal lung volume Full expiration with maximal effort Maximal inspiration back to maximal lung volume End of forced expiration criteria requires a plateau and maximum exhalation time of 15 s Minimum of 6 s expiratory time removed	Acceptability and reproducibility criteria Methodology for bronchodilator response testing Updated definitions and criteria for analysis of manoeuvres Standardised cues, feedback and warnings to operator	Use of the ATS standardised report [12] Data storage and electronic patient records to comply with data protection

ISO: International Organization for Standardization; ATS: American Thoracic Society.

TABLE 2

Synopsis of the diffusing capacity of the lung for carbon monoxide (D_LCO) skills workshop

Calibration, QC and settings	Technical aspects	Standardisation of test performance	Reporting and interpretation
Check ambient conditions (use a reliable barometer and thermometer) Ensure the correct system settings for dead space, pressure range, volume, and BTPS correction Accurate calibration for volume and pressure Check volume accuracy ±75 mL 0–90% response time ≤150 ms Linearity: ≤0.5% of full scale Accuracy: ±1% of full scale Adjust for lag and response time QC using regular biological controls Quality assurance using syringe or D_LCO gas simulator	Interference from 5% CO₂ or 5% water vapour ≤10 ppm error in CO Drift for CO ≤10 ppm over 30 s Drift for tracer gas ≤0.5% of full scale over 30 s BHT 10±2 s	Maximum time for unforced exhalation to RV is ≤12 s V_insp target of ≥90% of largest VC in same lung function testing session V_insp ≥85% of VC is acceptable if V_A is within 200 mL or 5% of highest V_A from acceptable D_LCO trial V_insp must be <4 s, longer V_insp must be noted on report Exhalation post-BHT past sample collection on classic systems <4 s Exhalation to RV post BHT on RGA systems can be up to 12 s Between test wait time: 4 min, 10 min for patient with severe airflow obstruction (on RGA, check tracer gas concentration at end-exhalation ≤2% of the inspired concentration) Must remain seated during wait time Recommended to check end-exhalation CO levels prior to inhalation of test gas; this can be used to adjust to the test for CO back-pressure and calculate COHb; allows compensation for water vapour and CO₂ effects Repeatability requirement: there must be at least two acceptable manoeuvres that are within 2 mL·min⁻¹·mmHg⁻¹ (0.67 mmol·min⁻¹·kPa⁻¹) of each other	Record when last cigarette was smoked Always use D_LCO corrected for Hb and COHb where applicable Clearly state if no recent Hb is available Report the grading of the D_LCO manoeuvres Record altitude

QC: quality control; BTPS: body temperature and pressure, saturated; BHT: breath-holding time; RV: residual volume; V_insp: inspiratory volume; VC: vital capacity; V_A: alveolar volume; RGA: rapid gas analyser; COHb: carboxyhaemoglobin; Hb: haemoglobin.