International consensus on lung function testing during COVID-19 pandemic and beyond
- Aisling McGowan1,2⇑,
- Pierantonio Laveneziana3,4,
- Sam Bayat5,6,
- Nicole Beydon7,
- P. W. Boros8,
- Felip Burgos9,
- Matjaž Fležar10,11,
- Monika Franczuk8,
- Maria-Alejandra Galarza3,4,
- Adrian H. Kendrick13,14,15,
- Enrico Lombardi16,
- Jellien Makonga-Braaksma17,
- Meredith C. McCormack18,
- Laurent Plantier19,20,
- Sanja Stanojevic21,
- Irene Steenbruggen22,
- Bruce Thompson23,
- Allan L. Coates24,
- Jack Wanger25,
- Donald W. Cockcroft26,
- Bruce Culver27,
- Karl Sylvester28,29 and
- Frans De Jongh30
- 1Department of Respiratory & Sleep Diagnostics, Connolly Hospital, Dublin, Ireland
- 2School of Physics, Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
- 3Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- 4AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, sites Pitié-Salpêtrière, Saint-Antoine et Tenon, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée (Département R3S), Paris, France
- 5Centre Hospitalier Universitaire de Grenoble Alpes, Unité d'Explorations Fonctionnelles, Cardiorespiratoires, France
- 6Université Grenoble Alpes – INSERM UA7, Rayonnement Synchrotron pour la Recherche Biomédicale (STROBE), France
- 7Unité Fonctionnelle de Physiologie-Explorations Fonctionnelles Respiratoires, AP-HP Sorbonne Université, Hôpital Armand-Trousseau, Paris, France
- 8Lung Pathophysiology Department, National Tuberculosis & Lung Diseases Research Institute, Warsaw, Poland
- 9Department of Pulmonary Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, CIBERES, Barcelona, Spain
- 10University Clinic of Respiratory and Allergic Diseases Golnik, Slovenia
- 11Medical faculty, University of Ljubljana, Slovenia
- 12Respiratory Physiopathology Assembly, Polish Respiratory Society
- 13Department of Respiratory Medicine, University Hospitals Bristol & Weston NHS Trust, Bristol, England
- 14University of West of England, Bristol, England
- 15School of Physiology, Pharmacology & Neurophysiology, University of Bristol, Bristol, England
- 16Pediatric Pulmonary Unit, “Anna Meyer” Pediatric University-Hospital, Florence, Italy
- 17Lung Function Department, Meander Medisch Centrum Amersfoort, The Netherlands
- 18Pulmonary Function Laboratory, Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
- 19Pulmonology and Lung Function Testing, CHRU de Tours, Tours, France
- 20University of Tours, CEPR/Inserm UMR1100, Tours, France
- 21Department of Community Health and Epidemiology, Dalhousie University, Nova Scotia, Canada
- 22Pulmonary Function Department, Isala Hospital, Zwolle, The Netherlands
- 23Faculty of Health, Arts and Design, Swinburne University of Technology, Victoria, Australia
- 24Division of Respiratory medicine, Dept of Pediatrics, Physiology and Environmental Medicine, Research Institute, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- 25Pulmonary Function Testing and Clinical Trial Consultant, Rochester, Minnesota, USA
- 26Division of Respirology, Critical Care and Sleep Medicine, Department of Medicine, at the University of Saskatchewan
- 27Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA
- 28Cambridge Respiratory Physiology, Cambridge University Hospital, UK
- 29Royal Papworth Hospital, UK
- 30Lung function lab, Medisch Spectrum Twente, Enschede, The Netherlands
- Aisling McGowan (aisling.mcgowan1{at}hse.ie)
Abstract
COVID-19 has negatively affected the delivery of respiratory diagnostic services across the world due to the potential risk of disease transmission during lung function testing. Community prevalence, reoccurrence of COVID-19 surges, and the emergence of different variants of the SARS-CoV-2 virus have impeded attempts to restore services. Finding consensus on how to deliver safe lung function services for both patients attending and for staff performing the tests are of paramount importance.
This international statement presents the consensus opinion of 23 experts in the field of lung function and respiratory physiology balanced with evidence from the reviewed literature. It describes a robust roadmap for restoration and continuity of lung function testing services during the COVID-19 pandemic and beyond.
Important strategies presented in this consensus statement relate to the patient journey when attending for lung function tests. We discuss appointment preparation, operational and environmental issues, testing room requirements including mitigation strategies for transmission risk, requirement for improved ventilation, maintaining physical distance, and use of personal protection equipment. We also provide consensus opinion on precautions relating to specific tests, filters, management of special patient groups, and alternative options to testing in hospitals.
The pandemic has highlighted how vulnerable lung function services are and forces us to re-think how long term mitigation strategies can protect our services during this and any possible future pandemic. This statement aspires to address the safety concerns that exist and provide strategies to make lung function tests and the testing environment safer when tests are required.
Footnotes
This manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.
Conflict of interest: Ms. McGowan has nothing to disclose.
Conflict of interest: Dr. Laveneziana reports personal fees from NOVARTIS France, personal fees from CHIESI France, personal fees from BOEHRINGER France, outside the submitted work.
Conflict of interest: Dr. BAYAT has nothing to disclose.
Conflict of interest: Dr. Beydon has nothing to disclose.
Conflict of interest: Dr. Boros has nothing to disclose.
Conflict of interest: Dr. Burgos reports and Scientific Advisory Board Medical Graphics Coorporation Diagnostics.
Conflict of interest: Dr. Fležar has nothing to disclose.
Conflict of interest: Dr. Franczuk reports personal fees from AstraZeneca, personal fees from Boehringer Ingelheim, personal fees from Chiesi, outside the submitted work.
Conflict of interest: Dr. GALARZA-JIMENEZ has nothing to disclose.
Conflict of interest: Dr. Kendrick has nothing to disclose.
Conflict of interest: Dr. Lombardi reports non-financial support from AbbVie, personal fees from Angelini, personal fees from Boehringer, personal fees and non-financial support from Chiesi, personal fees from GSK, non-financial support from Lusofarmaco, personal fees and non-financial support from Novartis, personal fees from Omron, grants and non-financial support from Restech, grants and personal fees from Sanofi, personal fees and non-financial support from Vertex, personal fees from Vifor, outside the submitted work.
Conflict of interest: Ms. Makonga-Braaksma has nothing to disclose.
Conflict of interest: Dr. McCormack reports royalties from UpToDate, personal fees from Vera Med, personal fees from Glaxo Smith Kline, personal fees from Celgene, outside the submitted work.
Conflict of interest: Dr. Plantier has nothing to disclose.
Conflict of interest: Dr. Stanojevic has nothing to disclose.
Conflict of interest: Dr. Steenbruggen has nothing to disclose.
Conflict of interest: Dr. Thompson has nothing to disclose.
Conflict of interest: Dr. Coates has nothing to disclose.
Conflict of interest: Dr. Wanger has nothing to disclose.
Conflict of interest: Dr. Cockcroft reports and Medical advisory board Pharmaxis.
Conflict of interest: Dr. Culver has nothing to disclose.
Conflict of interest: Dr. Sylvester has nothing to disclose.
Conflict of interest: Dr. de Jongh has nothing to disclose.
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- Received October 23, 2021.
- Accepted October 31, 2021.
- Copyright ©The authors 2021
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