RT Journal Article
SR Electronic
T1 Are aerosols generated during lung function testing in patients and healthy volunteers? Results from the AERATOR study
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP thoraxjnl-2021-217671
DO 10.1136/thoraxjnl-2021-217671
A1 Sadiyah Sheikh
A1 Fergus W Hamilton
A1 George W Nava
A1 Florence K A Gregson
A1 David T Arnold
A1 Colleen Riley
A1 Jules Brown
A1 AERATOR Group
A1 Jonathan P Reid
A1 Bryan R Bzdek
A1 Nicholas A Maskell
A1 James William Dodd
YR 2021
UL http://thorax.bmj.com/content/early/2021/11/02/thoraxjnl-2021-217671.abstract
AB Pulmonary function tests are fundamental to the diagnosis and monitoring of respiratory diseases. There is uncertainty around whether potentially infectious aerosols are produced during testing and there are limited data on mitigation strategies to reduce risk to staff. Healthy volunteers and patients with lung disease underwent standardised spirometry, peak flow and FENO assessments. Aerosol number concentration was sampled using an aerodynamic particle sizer and an optical particle sizer. Measured aerosol concentrations were compared with breathing, speaking and voluntary coughing. Mitigation strategies included a standard viral filter and a full-face mask normally used for exercise testing (to mitigate induced coughing). 147 measures were collected from 33 healthy volunteers and 10 patients with lung disease. The aerosol number concentration was highest in coughs (1.45–1.61 particles/cm3), followed by unfiltered peak flow (0.37–0.76 particles/cm3). Addition of a viral filter to peak flow reduced aerosol emission by a factor of 10 without affecting the results. On average, coughs produced 22 times more aerosols than standard spirometry (with filter) in patients and 56 times more aerosols in healthy volunteers. FENO measurement produced negligible aerosols. Cardiopulmonary exercise test (CPET) masks reduced aerosol emission when breathing, speaking and coughing significantly. Lung function testing produces less aerosols than voluntary coughing. CPET masks may be used to reduce aerosol emission from induced coughing. Standard viral filters are sufficiently effective to allow guidelines to remove lung function testing from the list of aerosol-generating procedures.