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ARTP Statement on Pulmonary Function Testing 2020

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ARTP Statement on Pulmonary Function Testing 2020 Guidelines BMJ Open Resp Res: first published as 10.1136/bmjresp-2020-000575 on 5 July 2020. Downloaded from ARTP statement on pulmonary function testing 2020 Karl Peter Sylvester,1,2 Nigel Clayton,3 Ian Cliff,4 Michael Hepple,4 Adrian Kendrick,5 Jane Kirkby,6 Martin Miller,7 Alan Moore,8 Gerrard Francis Rafferty,9 Liam O'Reilly,10 Joanna Shakespeare,10 Laurie Smith ,6,11 Trefor Watts,12 Martyn Bucknall,13 Keith Butterfield14 To cite: Sylvester KP, ABSTRACT UK. These recommendations set out the Clayton N, Cliff I, et al. ARTP The Association for Respiratory Technology & Physiology requirements and considerations that need statement on pulmonary (ARTP) last produced a statement on the performance to be made in terms of environmental and function testing 2020. of lung function testing in 1994. At that time the focus patient factors that may influence both the BMJ Open Resp Res was on a practical statement for people working in lung 2020; :e000575. doi:10.1136/ performance and interpretation of lung 7 function laboratories. Since that time there have been bmjresp-2020-000575 many technological advances and alterations to best function tests. They also incorporate proce- practice in the measurement and interpretation of lung dures to ensure quality assured diagnostic Received 6 February 2020 function assessments. In light of these advances an update investigations that include those associated Revised 11 February 2020 was warranted. ARTP, therefore, have provided within Accepted 14 February 2020 with equipment, the healthcare professional this document, where available, the most up-to- da te and conducting the assessments and the results evidence-based recommendations for the most common achieved by the subject. Each section aims to lung function assessments performed in laboratories outline the common parameters provided for across the UK. These recommendations set out the requirements and considerations that need to be made each investigation, a brief principle behind in terms of environmental and patient factors that may the measurements (where applicable), and copyright. influence both the performance and interpretation of lung suggested acceptability and reproducibility function tests. They also incorporate procedures to ensure criteria. quality assured diagnostic investigations that include those It has been over 10 years since the compre- associated with equipment, the healthcare professional hensive series of joint American Thoracic conducting the assessments and the results achieved Society/European Respiratory Society (ATS/ by the subject. Each section aims to outline the common 2–5 ERS) statements on lung function testing. http://bmjopenrespres.bmj.com/ parameters provided for each investigation, a brief principle behind the measurements (where applicable), and One of the problems arising from those has suggested acceptability and reproducibility criteria. been the view that patients either pass or fail the criteria set down in those statements. This was not the intention of the group who prepared those statements. Aspects of this have been addressed in the 2019 update of FOREWORD 6 The Association for Respiratory Technology the spirometry statement. Also an updated & Physiology (ARTP) was at the forefront of standard for single- breath carbon monoxide (CO) uptake transfer factor was published producing useable and readable guidelines 7 on how to undertake lung function testing.1 in 2017 which, in particular, incorporated on September 30, 2021 by guest. Protected The emphasis then was on a practical state- changes in gas analyser technology. ment that would be a helpful reference for We have been clear that the reason for people working in lung function testing. The setting out the ARTP view on lung function ARTP have now produced this revised and testing is to help ensure that each individual © Author(s) (or their expanded statement on lung function testing patient has the greatest chance of achieving employer(s)) 2020. Re- use with the emphasis still being that it can be their best result on the day of their tests. In permitted under CC BY- NC. No no sense should a patient ever pass or fail the commercial re- use. See rights used in lung function laboratories as a means and permissions. Published by to improve the quality and reliability of the test session. BMJ. results achieved by patients. The statements in these guidelines about For numbered affiliations see ARTP have provided within this docu- criteria that should be satisfied when under- end of article. ment, where available, the most up-to- date taking lung function testing outline goals and drivers that lead to ensuring a patient Correspondence to and evidence-based recommendations for Dr Karl Peter Sylvester; the most common lung function assess- achieves the best results possible on the day of karl. sylvester@ nhs. net ments performed in laboratories across the their test. If a patient does not meet all these Sylvester KP, et al. BMJ Open Resp Res 2020;7:e000575. doi:10.1136/bmjresp-2020-000575 1 Open access BMJ Open Resp Res: first published as 10.1136/bmjresp-2020-000575 on 5 July 2020. Downloaded from criteria, it does not invalidate any of the results obtained. in stockinged feet against a wall. Traditionally, this has It may just mean that those results may not be a reliable been calculated as the arm span/1.03 for males and indicator of what the patient might be able to achieve. arm span/1.01 in females. However, it has recently However, the results produced may still provide sufficient been observed that differences between arm span information to support any clinical decision- making with and standing height are related to ethnicity, sex and the proviso that a repeat test at another test session might age.14 The calculations are complex, but a program yield a different result. that estimates standing height from arm span, age We hope this document proves to be accessible and and ethnicity can be downloaded from the spirXpert sufficiently comprehensive that it will assist pulmonary website (https:// spirxpert. ers- education. org/ en/ function laboratories in delivering the best outcomes for download/ armspan- to- height- software/). their patients. Some patients may not be able to extend their arms, so Dr Karl Sylvester, Past Chair, ARTP 2020 alternatives are needed. KEY MESSAGES ► Demi- span: This is measured with the subject standing ► This statement outlines the latest best practice guid- upright with their back straight, arms extended side- ance for the performance of the most common lung ward at 90° to the torso, fingers stretched, and the function assessments in a respiratory physiology arm rested against a wall to avoid forward or backward department bending. Arm span is twice the measured demi- span. ► Reccomendations are provided on how to undertake ► Ulnar length: This has been reported as an alternative. these assessments safely, to quality assured standards Ulna length can be obtained in sitting position with and utilising the most suitable reference values avail- the left forearm resting comfortably on a table. The able for the interpretation of results palm faces downwards, and the fingers are extended together. The elbow should be bent at 90°–110°. The proximal end of the ulna is located by palpating GENERAL PROCEDURES along its length. The tip of the styloid process is felt The subject should be correctly prepared for the tests at the wrist by palpating down the length of the bone and various subject details recorded. distally until its end is felt. Generally, a set of callipers The subject’s age is recorded (to one decimal place), is used to obtain an accurate measure. As with demi- height to the nearest 0.5 cm and weight to the nearest span and arm span, there is a choice of equations, copyright. 0.5 kg (wearing indoor clothes without shoes). some of which contain age and ethnicity as important Standing height is a key measurement as it is commonly factors.15 Which equation is used should be stated on used to estimate predictive values for the majority of the report form. indices used in evaluating the pulmonary function of ► Knee height: This is generally used in nutrition studies both children and adults. in the elderly,16 17 where standing height may be diffi- ► Standing height: This should be measured without cult to obtain easily.18 Knee height is the distance http://bmjopenrespres.bmj.com/ shoes, with the feet together, heels, scapulae and between the lower edge of the heel and the upper buttocks against the stadiometer/wall, standing as part of the knee (just above the kneecap) measured tall as possible with the eye level looking straight with the subject in sitting position, legs hanging over ahead (Frankfurt plane) using an accurate measuring the edge of the chair, and knees and hips bent at 90°. 5 device. Because height increases with increasing age The tape measure is placed along the outside of the during childhood and decreases with increasing age leg, parallel to the major axis of the tibia. in adulthood, particularly in older subjects, height The gender of a subject is the way they portray them- should ideally be measured on every occasion when selves within society and may differ from their birth measurements of lung function are being made to sex. For the purposes of assessing lung function, it is ensure that accurate diagnosis and classification of the subject’s birth sex (more correctly, the biological 8–11 on September 30, 2021 by guest. Protected disease severity are maintained. sex through puberty) that determines the size of their However, standing height measurements may not be lungs. Birth sex should therefore be used in the context reliable in patients with thoracic skeletal deformities, of prediction of lung function and not gender. Failure the elderly or in patients who have certain syndromes, to address this correctly may mean a transgender patient 12 13 such as achondroplasia and osteogenesis imperfecta.
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