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 (DLCO) 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 DLCO 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
Vinsp target of ≥90% of largest VC in same lung function testing session
Vinsp ≥85% of VC is acceptable if VA is within 200 mL or 5% of highest VA from acceptable DLCO trial
Vinsp must be <4 s, longer Vinsp 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 DLCO corrected for Hb and COHb where applicable
Clearly state if no recent Hb is available
Report the grading of the DLCO manoeuvres
Record altitude
QC: quality control; BTPS: body temperature and pressure, saturated; BHT: breath-holding time; RV: residual volume; Vinsp: inspiratory volume; VC: vital capacity; VA: alveolar volume; RGA: rapid gas analyser; COHb: carboxyhaemoglobin; Hb: haemoglobin.