Open Access
Focus on Covid-19

Conducting spirometry in general practice. Infection control during the COVID-19 pandemic

Kerry Hancock, Richard Parsons, David Schembri
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Abstract

All healthcare guidelines endorse spirometry as best practice for measuring patients’ lung function. However, with more than 500 health worker infections in Australia by July 2020, there is increasing concern about health worker protection. This article discusses the issues surrounding lung function testing in point-of-care settings such as general practice and summarises the current recommendations for infection control.

Key Points

  • Spirometry is recognised as the gold standard for diagnosing and managing chronic airways diseases.
  • However, the virus responsible for COVID-19 can be transmitted via droplets and air.
  • On 25 March 2020, the Thoracic Society of Australia & New Zealand and Australian & New Zealand Society of Respiratory Science recommended suspension of all lung function testing unless clinically essential.
  • On 27 April 2020, they updated their advice to state that pulmonary function testing could be performed under certain circumstances.
  • GPs and their staff who conduct spirometry understandably are concerned about how to proceed.
  • This article discusses the issues surrounding lung function testing and summarises the current recommendations for infection control.

Spirometry is recommended as an indispensable tool for diagnosing, differentiating and monitoring chronic airways diseases. It has considerable impact on the accuracy of diagnosis and clinical management of patients with chronic obstructive pulmonary disease (COPD) and asthma at the point of patient care, especially in general practice.1-10 All national and international healthcare guidelines endorse spirometry as best practice for measuring patients’ lung function.2-5

COVID-19 (coronavirus disease), caused by the SARS-CoV-2 virus, emerged in December 2019 in Wuhan, China. This novel coronavirus initially caused a national outbreak of severe pneumonia in China, and rapidly spread around the world as a pandemic. The virus is expelled as droplets from the respiratory tract of an infected individual  (e.g. during coughing and sneezing) directly onto a mucosal surface or conjunctiva of a susceptible individual or an environmental surface. However, because of evaporation, even a single large droplet may reduce in diameter and become airborne during its trajectory. It is currently understood that transmission of the virus is highly likely to be by both droplet and airborne routes.11

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With more than 500 health worker infections in Australia by July 2020, there is increasing concern about health worker protection and that current infection control guidelines are not aligned with the growing body of scientific evidence around transmission and prevention of SARS-CoV-2 infection.12 Very few cases of infection transmission via spirometers have been documented before the COVID-19 pandemic, with the risk of serious infection to patients and spirometry operators reduced by usual standard infection control procedures (SICPs), including single-use consumables, vaccination (e.g. against influenza, pertussis and tuberculosis) or access to medication. Despite this, spirometry equipment has the potential to transmit pathogens by direct contact with surfaces and items such as mouthpieces, hand-held devices, valves and tubing or by indirect transmission during expiratory manoeuvres and through the patient’s coughing or sneezing.13

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Dr Hancock is a GP at Chandlers Hill Surgery, Adelaide. Mr Parsons and Mr Schembri are Senior Respiratory Scientists at the Department of Respiratory Medicine, Southern Adelaide Local Health Network, Adelaide, SA.