Spirometry, the most frequently performed pulmonary function test (PFT), is the cornerstone of occupational respiratory surveillance programs. Hundreds of thousands of spirometry tests are performed each year in the U.S. to comply with occupational regulatory requirements.
However, during the current outbreak of coronavirus disease (COVID-19), the American College of Occupational and Environmental Medicine (ACOEM) believes it is prudent to suspend spirometry testing in the workplace, unless it is determined to be clinically essential, due to the significant risk of transmitting COVID-19. Spirometry tests require performance of a forced expiratory maneuver which could spread droplets in the air if an infected person is tested, even if asymptomatic. The risk of other individuals inhaling the droplets exists even if the likelihood of this occurring is unknown.
Because of this risk, many pulmonary function testing (PFT) labs have temporarily closed. Other labs are not measuring lung volumes with body plethysmography, and others are limiting testing only to essential tests. In addition, many directors of spirometry courses approved by the National Institute for Occupational Safety and Health (NIOSH) are postponing courses that were scheduled for the near future. An infected student (even if asymptomatic) practicing forced vital capacity (FVC) maneuvers in class might exhale virus-containing droplets which could infect another student.
Most routine occupational spirometry testing is driven by protocols and is not usually medically essential on an acute basis. Consequently, under these circumstances and until more is known about COVID-19, ACOEM recommends spirometry testing be discontinued in all but medically essential cases as determined by an occupational physician or a pulmonologist.
This approach is consistent with recent recommendations by federal agencies concerning personal respiratory protection. The Occupational Safety and Health Administration (OSHA) recently temporarily suspended requirements for annual respiratory protection fit testing (Temporary Enforcement Guidance -- Healthcare Respiratory Protection Annual Fit-Testing for N95 Filtering Facepieces During the COVID-19 Outbreak
). OSHA advises to perform an initial fit test using a qualitative method and to suspend annual fit-testing requirements during the pandemic. OSHA reiterated the need to perform user seal checks when the respirator is donned. In addition, the U.S. Centers for Disease Control and Prevention (CDC) has issued " Strategies for Optimizing the Supply of N95 Respirators: Crisis/Alternate Strategies
," in the event of reduced or inadequate supply.
Occupational and environmental health practitioners are advised to watch for any guidance from CDC
, and the Food and Drug Administration
. In addition, please monitor the ACOEM COVID-19 page
and our social media channels
for continued updates.
Thank you and be well.
Stephen A. Frangos, MD, MPH, FACOEM