COVID-19 has highlighted the need to adjust routine practices for lung function testing in an effort to reduce potential spread, for both patients and staff.   A Pulmonary Diagnostics working group was established from the Leadership Committee, and has been reviewing re-opening strategies for lung function procedures in response to the Ministry of Health’s (MOH) updated Directive #2 (http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/directives/RHPA_professionals.pdf), which calls for staged ramp-up of elective tests and procedures.  COVID-19 screening will be more challenging for patients with lung disease due to similarities in symptoms.  Asymptomatic spread of COVID-19 will be an ongoing concern for some time to come.

The European Respiratory Society (ERS) (www.ersnet.org) published recommendations for lung function testing during the COVID-19 pandemic and beyond, which included staged precautions to consider early during the pandemic surge.  It was much easier to close services than to re-open with enhanced precautions.  We need more specific recommendations to support re-opening efforts for Pulmonary Function Labs, Asthma/COPD clinics, Primary Care and Family Health Teams who perform lung function procedures.  The American Thoracic Society (ATS) and Canadian Thoracic Society (CTS) are both working on publications on this topic, as of this writing.

The goal of this work in relation to pulmonary diagnostics is to minimize potential COVID-19 exposure and spread.  We are asking patients to leave their self-isolating lives, travel in for testing, and undergo more screening than ever.  Testing will require operators to have close and prolonged contact with patients, depending on the test procedures ordered.  Reconfiguring testing spaces, revisiting environmental control measures, enhancing cleaning and disinfection procedures, and physical distancing measures all create several challenges.  Operational capacity and test prioritization will be relative to your local COVID-19 prevalence.  Public Health Ontario and Health Canada have published recommendations relating to COVID-19; these publications list a number of items to discuss with local infection control when developing re-opening plans for lung function testing.

Testing deferred due to COVID-19 surge will represent a considerable backlog.  Temporary adjustments in funding requirements, such as the MOH/Ministry of Long-Term Care Exceptional Access Program (EAP) and the Assistive Devices Program’s (ADP) Home Oxygen Program, have provided some relief.

There is ongoing discussion on the specific PPE and environmental controls required during procedures that hold the potential to generate more bio-aerosols and/or those which require administration of medical aerosols.  The relative risk of spreading COVID-19 infection from our exhaled breath is not well studied and therefore practices from surveyed PFT labs are currently inconsistent.

Completing a Point of Care Risk Assessment (PCRA) coupled with donning and doffing with enhanced precautions requires more time per visit, and test capacity will be affected for some time.  Prioritization of essential testing will be needed in order to meet the needs.

Tony Kajnar, RRT/AA RCPT(P)

About the author:  Tony Kajnar, RRT/AA RCPT(P), is currently the RTSO Pulmonary Diagnostics Advisor and has been a volunteer member of the RTSO Leadership Committee since 2017.  He was awarded with the RTSO Pinnacle Award in 2019 for being a champion, leader, educator and advocate in the field of Pulmonary Diagnostics.

Tony currently works as a Senior Therapist in the Sault Area Hospital Pulmonary Function Lab.  He is certified with the Canadian Association of Cardio-Pulmonary Technologists, and is Co-Chair of the Canadian Pulmonary Function Symposium.

Tony graduated from the Fanshawe College Respiratory Therapy Program in 1994, and the Michener Institute’s (now Michener Institute of Education at UHN) Advanced Anaesthesia Assistant (AA) Program in 2009.

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