Spirometry is a standard pulmonary function test that measures how well a person moves air in and out of the lungs. Workers who inhale some types of dust, gases, or other air contaminants can, over time, experience lung damage. The spirometry test may detect breathing problems or significant changes in a worker’s lung function early.

1)  The Patient

• Assess the need for testing: Base the decision to test or defer on several considerations: 1) does the risk to patient and staff outweigh the risk to the patient of deferring testing; 2) is testing required by a government or employer standard? (Enforcement memo defers OSHA-mandated spirometry testing as long as the employer makes a good-faith effort to obtain the tests. Affected standards are listed in the Appendix); and 3) if a baseline test is required to qualify a new employee, can this information be obtained from other sources?
• Routine periodic surveillance testing: In general, such testing should be delayed until the prevalence of COVID-19 disease in the community is deficient and extensive exposure control in the testing facility has been instituted. OSHA has provided an enforcement memo supporting the deferral of such testing for an indefinite time.1 ACOEM has also issued a statement supporting this view. 

2)  New patient testing: The occupational physician should use expert judgment to determine if there is a bona fide reason to conduct the testing at this time or if it may be delayed.

• Clinical diagnostic testing: In some cases, necessary tests can be referred to a pulmonary function testing (PFT) lab, where testing can be done in a more controlled setting.
• Communicate with patients, employers, and other clinicians about the appropriateness of testing. Occupational physicians should discuss which testing is needed and which may be appropriately deferred. Physicians should work jointly with employers and/or regulatory agencies to explain the necessity.
• Prescreen patients to detect those who are infected, symptomatic, and capable of transmitting disease.
  
• Patients must be screened with a questionnaire and temperature check on the day of testing. The questionnaire should elicit any history of exposure to COVID-19 within the past two weeks, exhibiting any COVID-19 symptoms, and/or recent travel to high-risk areas. If positive, a spirometry test should not be performed but rescheduled.
• Passing the pre-screening test does not indicate that a patient is not infected. The patient may be infected but asymptomatic or pre-symptomatic and can infect others.
• With future improvements in speed, availability, and accuracy in ruling out SARS-CoV-2 infection, nucleotide amplification assay tests (NAATs) or other antigen tests may become a practical screening method. This is currently not the case.