ACOEM Advises Suspension of Routine Occupational Spirometry Testing During COVID-19 Pandemic

Effective immediately, spirometry (pulmonary functional testing) WILL NOT be performed as part of respirator medical clearance, in accordance with the guideline below from the American College of Occupational and Environmental Medicine.  Routine respirator clearance will be evaluated either through the respirator questionnaire, respirator physical examination and/or chest x-ray on a case-by-case basis.  PLEASE NOTE:

  • Routine spirometry as required by OSHA for Silica, Asbestos or Coal exams will not be performed but clearance for respirator use will be assessed.  If otherwise qualified, these employees will be provided a time-limited clearance of 6 months with recommended reassessment of their respiratory fitness, including spirometry based on the expectation that spirometry testing will be deemed acceptable at that time.
  • Fit-Testing:  OSHA advises performing an initial fit test using a qualitative method and the suspension of annual fit-testing during the pandemic.  OSHA reiterated the need to perform user seal-checks when the respirator is donned.

Explanation:

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 Face pieces 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.