New technical standards for spirometry

Exciting times in spirometry! The official “Standardization of Spirometry” technical statement of the American Thoracic Society (ATS) and the European Respiratory Society (ERS) was published in 2019. As this documented was last updated 15 years ago this long-awaited update is BIG NEWS and signifies exciting times for all of us in how we understand and will practice spirometry from here forward.

Both manufacturers and operators have adjustments to make to old practices to ensure spirometry equipment, reports and practices meet the new standard. This can look complicated and difficult to decipher but don’t get your knickers in a knot about this – we will translate the key changes into simple snippets in future posts on this platform. To keep you excited for the next instalments here are a few of the various aspects you can look forward to hearing more about:

More stringent criteria for volume and linearity calibration checks. 

If you think attaining a deviation of ≤ +/- 3.5% between the syringe and measured volumes when checking your spirometer was tricky, you will have to practice your coordination skills as you deftly move the calibration syringe plunger to attain a deviation of +/-3% at low, medium and high flow rates going forward. Additionally, daily linearity calibration checks are mandatory rather than just a simple volume calibration check that had been practised in the past. If you have no idea what I am talking about, I will explain more about calibration verification procedures in the next blogs coming out. You could also join an Education for Health Africa training course at any one of our venue’s countrywide. 

Operator training and attainment of competency requirements

Operator training is mandatory and must be integrated into any spirometry testing service.

Relative contraindications

A new list of relative contraindications has been supplied for consideration when a spirometry test is required. Additionally, the previous absolute contraindication of testing any patient who has had a myocardial infarction in the past month has been changed to no testing allowed on any patient having had a myocardial infarction within the last week.

Activities that patients must avoid prior to testing

The list of activities that the subject should avoid prior to testing has been updated.

More stringent acceptability and repeatability criteria

The back extrapolated volume (BEV) criteria has been reduced from <150mls or 5% of the FVC to <100mls or 5% of the FVC whichever is the greater. The rise time (RT) (10% to 90% from start to peak) has been added for assessment of the start of the blow and should be ≤150ms. When assessing the end of test (EOT), the terminology has been changed to end of forced expiration (EOFE). The previous criteria of a minimum expiratory time has been eliminated.

New terminology for reversibility testing

The previous term “reversibility testing” has been replaced by “Bronchodilator responsiveness testing” to avoid the inference that reversibility signifies the complete elimination of airway obstruction. A new table for the withholding of medication prior to bronchodilator testing has been provided. An example procedure for bronchodilator administration via nebulisation has been added to the example procedure for bronchodilator administration via MDI and spacer. Systems are now required to flag a warning to the operator if the wait time between pre and post-bronchodilator testing has not been met.

Operator reporting requirements

A drop-down menu for standardised operator feedback is required which promotes standardised reporting and a quick quality control checklist for the operator.

A new grading system 

The grading system published in the 2017 ATS Recommended Guidelines to a Standardised Pulmonary Function Report should be used.

These are exciting times for us all to improve the quality of spirometry testing. We are looking forward to sharing more great information with you on spirometry.