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

PatientsEquipmentOperatorProcedureAnalysisQuality 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.