Is lung function testing safe during COVID-19 in the primary care setting?

20 Apr 2021

What the research says:

There is no evidence on the risk for COVID-19 transmission via aerosol-generating lung function tests in the primary care setting. Risk estimates have been largely extrapolated from indirect evidence and expert opinion. Lung function tests including peak expiratory flow rate and spirometry are associated with an increased risk for viral transmission via respiratory droplets. The COVID-19 virus is spread primarily via respiratory droplets. Respiratory aerosols have been implicated in viral transmission in medical settings, particularly from aerosol generating procedures. Contact with surfaces contaminated with viral particles can result in transmission if the individual then touches their face.

What this means for your clinical practice:

Our response is based on currently available indirect evidence.
Consider the reason for the proposed test. Lung function testing should only be conducted when it is considered essential or cannot be delayed, for a diagnosis or trial of treatment in which the result will guide/change treatment choice.
Screen patients for COVID-19. Lung function testing should be deferred for patients with a positive test result or who have been in recent contact (at least 14 days) with a person with a positive COVID-19 test result.
Patients with current respiratory symptoms suggestive of viral infection should not undergo lung function tests until their symptoms have resolved.
Use standard infection control measures for lung function testing including cleaning and maintenance of equipment, in-line viral filters and single use disposables.
Manage the risk droplet dispersal via cough following a lung function test in the usual way (e.g provide tissues for the patient to cough into, dispose of tissues as clinical waste and ensure the patient washes their hands).
Use proper personal protective equipment according to availability and National guidance. Consider using a plexiglass barrier if available. Maintain social distancing during and following the test.
Follow National guidance for cleaning/ventilation of clinical areas. Consider conducting peak expiratory flow tests outside the building if appropriate.

Useful links and supporting references:

Agency for Clinical Innovation. Lung function testing. COVID-19 advice. Available at: https://www.health.nsw.gov.au/Infectious/covid-19/communities-of-practice/Documents/lung-function-testing.pdf. Accessed March 2021

Association for Respiratory Technology & Physiology (ARTP) Guidance – Respiratory function testing and sleep services during endemic COVID-19. Available at: https://www.artp.org.uk/COVID19. Accessed March 2021

British Thoracic Society. Guidance for the resumption and continuation of urgent and elective outpatient respiratory services. Available at: https://www.brit-thoracic.org.uk/covid-19/covid-19-resumption-and-continuation-of-respiratory-services/. Accessed March 2021

Crimi C, et al. Practical considerations for spirometry during the COVID-19 outbreak: Literature review and insights. Pulmonology 2020. Available at: https://www.sciencedirect.com/science/article/pii/S2531043720301756?via%3Dihub. Accessed March 2021

European Respiratory Society. Recommendation from ERS Group 9.1 (Respiratory function technologists/Scientists) Lung function testing during COVID-19 pandemic and beyond. Available at: https://ers.app.box.com/s/zs1uu88wy51monr0ewd990itoz4tsn2h/ Accessed March 2021

Helgeson SA, et al. Aerosol generation during spirometry. Annal ATS 2020;17:1638–9. Available at : https://www.atsjournals.org/doi/pdf/10.1513/AnnalsATS.202005-569RL. Accessed April 2021

Khan S, et al. A regional Canadian expert consensus on recommendations for restoring exercise on lung function testing in low and moderate-to-high community prevalence coronavirus disease 2019 (COVID-19) settings. Available at: https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/regional-canadian-expert-consensus-on-recommendations-for-restoring-exercise-and-pulmonary-function-testing-in-low-and-moderatehigh-community-covid19-prevalence-settings/3DE66ECC8346C1D7C61DDB8AB0FAA3AD. Accessed March 2021

Milanese M, et al. Suggestions for lung function testing in the context of COVID-19. Respir Med 2020;177:106292. Available at: https://www.resmedjournal.com/article/S0954-6111(20)30432-7/fulltext. Accessed March 2021

New Brunswick Association of Respiratory Therapists. Position Statement Aerosol Generating Medical Procedures During an H1N1 Influenza A Pandemic. Available at: https://www.nbart.ca/en/nbart-position-statements/position-statement-aerosol-generating-medical-procedures-during-an-h1n1-influenza-a-pandemic.html. Accessed April 2021

Resource information

Respiratory conditions

COVID-19

Respiratory topics

Diagnosis
Spirometry

Type of resource

IPCRG COVID-19 and respiratory Q&A

Disclaimer

Page last reviewed on the date shown above.

The content is drawn from the references listed above. Wording has been adapted for clarity and applicability for the primary care context. The content does not imply direction by the IPCRG nor does it form a position of the IPCRG on this subject. The content may be adapted as new evidence arises. This content is advisory; it is intended for general use and should not be regarded as applicable to a speciﬁc case.

The International Primary Care Respiratory Group produces a range of answers to questions raised by our Sentinel Network for clinicians working in community settings. These are called the IPCRG Questions and Answers. Where possible, these are published using Creative Commons licences under the Attribution-NonCommercial-ShareAlike CC BY-NC-SA licence. This licence lets others remix, tweak, and build upon our work non-commercially, as long as they credit IPCRG and license their new creations under the identical terms. This enables member countries to adapt and translate for use in their country. Further information on the fine print can be found by reading the Legal Code. We would appreciate it if you would ask your colleagues to visit our site to obtain documents, rather than you sending them copies. By doing this they will be better able to understand and accept the CCL. The IPCRG Answer Review Group coordinates the views of primary care colleagues with specific regard to these answers. The views expressed in these answers are not necessarily those of the International Primary Care Respiratory Group. Should any author have a conflict of interest in regard to an answer, then this will be clearly stated in the answer document.

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Is lung function testing safe during COVID-19 in the primary care setting?

What the research says:

What this means for your clinical practice:

Useful links and supporting references:

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¿Es seguro hacer pruebas de función pulmonar en atención primaria durante la COVID-19? - Spanish

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