Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement

Brian L Graham, Irene Steenbruggen, Martin R Miller, Igor Z Barjaktarevic, Brendan G Cooper, Graham L Hall, Teal S Hallstrand, David A Kaminsky, Kevin McCarthy, Meredith C McCormack, Cristine E Oropez, Margaret Rosenfeld, Sanja Stanojevic, Maureen P Swanney, Bruce R Thompson, Brian L Graham, Irene Steenbruggen, Martin R Miller, Igor Z Barjaktarevic, Brendan G Cooper, Graham L Hall, Teal S Hallstrand, David A Kaminsky, Kevin McCarthy, Meredith C McCormack, Cristine E Oropez, Margaret Rosenfeld, Sanja Stanojevic, Maureen P Swanney, Bruce R Thompson

Abstract

Background: Spirometry is the most common pulmonary function test. It is widely used in the assessment of lung function to provide objective information used in the diagnosis of lung diseases and monitoring lung health. In 2005, the American Thoracic Society and the European Respiratory Society jointly adopted technical standards for conducting spirometry. Improvements in instrumentation and computational capabilities, together with new research studies and enhanced quality assurance approaches, have led to the need to update the 2005 technical standards for spirometry to take full advantage of current technical capabilities.Methods: This spirometry technical standards document was developed by an international joint task force, appointed by the American Thoracic Society and the European Respiratory Society, with expertise in conducting and analyzing pulmonary function tests, laboratory quality assurance, and developing international standards. A comprehensive review of published evidence was performed. A patient survey was developed to capture patients' experiences.Results: Revisions to the 2005 technical standards for spirometry were made, including the addition of factors that were not previously considered. Evidence to support the revisions was cited when applicable. The experience and expertise of task force members were used to develop recommended best practices.Conclusions: Standards and consensus recommendations are presented for manufacturers, clinicians, operators, and researchers with the aims of increasing the accuracy, precision, and quality of spirometric measurements and improving the patient experience. A comprehensive guide to aid in the implementation of these standards was developed as an online supplement.

Keywords: pulmonary function; spirometer; spirometry; technical standards.

Figures

Figure 1.
Figure 1.
Back-extrapolated volume (BEV). Time 0 is found by drawing a line with a slope equal to peak flow through the point of peak flow (red line) on the volume–time curve and setting Time 0 to the point where this line intersects the time axis. The BEV is equal to the volume of gas exhaled before Time 0 (inset), which, in these two examples from the same patient, is 0.136 L for the left panel (acceptable) and 0.248 L for the right panel (unacceptable). For this patient, the BEV limit is 5% FVC = 0.225 L.
Figure 2.
Figure 2.
Flowchart outlining the end of forced expiration (EOFE) acceptability criteria for FVC. *If there are no prior observed FVC values in the current pre- or post-bronchodilator testing set, then the FVC provisionally meets EOFE acceptability criteria.
Figure 3.
Figure 3.
Flowchart outlining application of acceptability and repeatability criteria.
Figure 4.
Figure 4.
Measurement of VC and IC. VC may be measured either as EVC (left panel) or IVC (right panel). In these examples, divisions on the volume axis are 1 L, and those on the time axis are 5 seconds. ERV = expiratory reserve volume; EVC = expiratory VC; IC = inspiratory capacity; IVC = inspiratory VC; RV = residual volume.

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