Martin R. Miller

This is a document produced by a joint ATS-ERS Task Force on lung function testing to provide new combined standards for Spirometry. It walks the reader through all the important elements of the test, from instrument to procedure quality control. One of the major steps forward is the recommendation that a standardised computer output format should be available on all instruments. This does not require equipment manufacturers to store their data in a specific format, but it does require them to provide a means of delivering the data in a standard way. This means that users won't be tied to a specific manufacturer in order to maintain their database structure. It also means that it will be relatively easy to write software to move spirometric data into healthcare databases where they can be used to monitor and guide therapy for patients with lung diseases. Such data can also be used for clinical research, including research into the efficacy of using pulmonary function tests in managing patients. Furthermore, International Organization for Standardization metrology terminology (www.iso.org) has been adopted.

This section is written to provide guidance in interpreting pulmonary function tests (PFTs) to medical directors of hospital-based laboratories that perform PFTs, and physicians who are responsible for interpreting the results of PFTs most commonly ordered for clinical purposes. Specifically, this section addresses the interpretation of spirometry, bronchodilator response, carbon monoxide diffusing capacity (DL,CO) and lung volumes.

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.

This is a document produced by a joint ATS-ERS Task Force on lung function testing to provide new combined standards for lung volume measurements. It largely reflects a document that was produced after an international workshop held in 1990, funded by the National Heart Lung and Blood Institute (NHLBI). That document was very large and never published in full print, but those interested in all the details can find it posted on the ATS website. In the new document, the relevant technical aspects and the limitations of the methods currently available for lung volume measurements are summarised in a user-friendly way. The position of lung volume measurements in the diagnosis of respiratory disorders and their cost-to-benefit ratio were probably the most controversial aspects of the Task Force.