Spirometry during the SARS-CoV-2 pandemic. Guidelines and practical advice from the expert panel of Respiratory Physiopathology Assembly of Polish Respiratory Society.

At the end of 2019, in Wuhan, the Hubei Province's capital city in China, the first cases of COVID-19 disease caused by the novel coronavirus, SARS-CoV-2, were described. The rapid spread of the infection through the world resulted in the World Health Organization announcing the COVID-19 a global pandemic in March 2020. The main routes of transmission of the novel coronavirus SARS-CoV-2, according to current evidence, are via droplets inhalation, direct contact with contaminated surfaces, and transmission via the mucous membranes of the mouth, nose, and eyes, and probably through airborne particles from the respiratory tract, generated during coughing and sneezing of infected individuals. During the pulmonary function testing (PFTs), which require strenuous breathing maneuvers and generate high-intensity airflow, aerosols, and micro-aerosols are formed from respiratory secretions and may contain viral and bacterial particles. Therefore, such forced respiratory maneuvers pose a significant risk of spreading the infection to patients and laboratory staff. According to current knowledge, the source of infection may also be an asymptomatic and a pre-symptomatic individual. Coronavirus SARS-CoV-2 has been increasingly prevalent in the community, and this increases a potential risk to all patients tested lung function and staff working there. As the patients' and staff's safety is of unprecedented importance, the additional precautions when performing pulmonary function tests are necessary and unquestionable. In consequence, the greater availability of consumables and personal protective equipment is indispensable. The reorganization of daily practice will prolong test time, reduce the number of tests performed, and slow down patients' flow. The guidance provides practical advice to health care professionals on performing pulmonary function tests during the COVID-19 pandemic. It has been developed basing on currently available information and recommendations from relevant health care institutions. As the COVID-19 pandemic is a rapidly evolving situation and the new scientific data has been becoming are available, the guidance will be updated over time.

GINA 2020: what's new and why?

The Global initiative against asthma (GINA) 2020 strategy has been released with some changes and updates. GINA recommends the continuation of medications, avoidance of nebulization and spirometry, and ensuring a written asthma action plan in COVID-19 times. GINA 2020 specifies which step of management is to be followed according to the patient's symptoms in an easy flowchart. Clinicians need to be aware of the changes and the evidence behind them.

Practical considerations for spirometry during the COVID-19 outbreak: Literature review and insights.

BACKGROUND: As the Coronavirus disease 2019 (COVID-19) is spreading worldwide, countries are dealing with different phases of the pandemic. Lately, scientific evidence has been growing about the measures for reopening respiratory outpatient services during the COVID-19 pandemic. We aim to summarize the key differences and similarities among recommendations by different national and international organizations. METHODS: We searched on Google and Pubmed for recently published National and International Recommendations/Guidelines/Position Papers from professional organizations and societies, offering a guidance to physicians on how to safely perform pulmonary function testing during COVID-19 pandemic. We also searched for spirometry manufacturers' operational indications. RESULTS: Indications on spirometry were released by the Chinese Task force, the American Thoracic Society, the European Respiratory Society, the Thoracic Society of Australia and New Zealand, the Société de Pneumologie de Langue Française, the Spanish Societies (Sociedad Espanola de Neumologia y Cirugia Toracica, Sociedad Espanola de Alergologia e Inmunologia Clinica, Asociacion de Especialistas en Enfermeria del trabajo, Asociacion de Enfermeria Comunitaria), the Sociedade Portuguesa de Pneumologia, the British Thoracic Society/Association for Respiratory Technology & Physiology, the Irish Thoracic Society, the Sociedad Uruguaya de Neumologia, the Italian Thoracic Society and the Italian Respiratory Society, Cleveland Clinic and Nebraska Medical Center. Detailed technical recommendations were found on manufacturers' websites. We found several similarities across available guidelines for safely resuming pulmonary function services, as well as differences in criteria for selecting eligible patients for which spirometry is deemed essential and advice which was not homogenous on room ventilation precautions. CONCLUSIONS: This study shows a synthesis of national/international guidelines allowing practicing physicians to adapt and shape the way to organize their outpatient services locally. There is generally good agreement on the importance of limiting pulmonary function testing to selected cases only. However, significant differences concerning the subsets of candidate patients, as well as on the management of adequate room ventilation, were observed.