Asthma, Spirometry and COVID-19

In late May, 2020, two articles were published on the use of lung function testing during the COVID-19 pandemic. On May 29th, the Lancet published “Lung function testing in the COVID-19 endemic” by James H Hull et al.  On May 24th, the Italian Journal of Pediatrics published “Italian Pediatric Respiratory Society Recommendations on Pediatric Pulmonary Function Testing During COVID-19 Pandemic” by Elisabetta Bignamini et al. The Lancet authors, in reference to spirometry, state, “This procedure requires patients to repeatedly undertake forced exhalatory manoeuvres and as such frequently precipitates coughing and the production of sputum. It also requires clinicians and patients to be in close proximity and thus, even with the use of device filters, in a COVID endemic phase, enhanced infection prevention and control is crucial.” Recognizing this concern, the Italian Journal of Pediatrics authors state, “Pulmonary function testing should be performed in children with chronic lung disease only if it is needed to guide management.” While spirometry is a key component of asthma diagnosis and management, the concerns expressed in these articles mirror statements from the American Academy of Allergy, Asthma, and Immunology (AAAAI) and the American Thoracic Society.  The AAAAI statement includes, “As things begin to open up there will be pressure to resume spirometry and ENO, but these will all require the use of full PPE (face mask, N95 respirator, gown, and gloves)…. As PPE becomes more available, spirometry and ENO could then be resumed in outpatient offices — provided full PPE is used, as per the CDC guidelines.”