Table 5.

Respiratory tests to be conducted in adult (consensus) and pediatric (no consensus) patients with suspected PID

First levela	Second levelb	Third levelc	N (Composition of panel)	Votes in agreement (%)	Degree of agreement
Adults
Refer to pulmonologist when warning signs detected	Spirometry* Plethysmography DLCO HRCT +/− abdominal ultrasound Sputum culture (bacteria, mycobacteria, and fungi), if expectoration	Exercise stress tests. Bronchoscopy with bronchoalveolar lavage and transbronchial cryobiopsy. Open lung biopsy or by video-assisted thoracoscopy in case of interstitial lung disease.	5 (AP)	100.0	Unanimity
Children
Spirometry, if possible according to patient age and availability  Chest X-ray	Spirometry (technically possible ≥3 years) Plethysmography (≥ 6–7 years, if available) DLCO (≥ 6–7 years) Lung HRCT +/− abdominal ultrasound Sputum culture, if expectoration (induced sputum, if no expectoration)	Lung function studies by age: • In infants: plethysmography; tidal volume determination; tidal or raised volume rapid thoracoabdominal compression technique. • In preschoolers: oscillometry; oscillatory resistance. Bronchoscopy with bronchoalveolar lavage, in the case of localized or diffuse bronchiectasis or interstitial lung disease, even if patient is expectorating. Open lung biopsy or video-assisted thoracoscopy in case of interstitial lung disease Transbronchial cryobiopsy in children > 7 years as alternative to lung biopsy	4 (PP)	50.0	Discrepancy

AP: adult pulmonologists; DLCO: diffusing capacity of the lung for carbon monoxide; HRCT: high-resolution computed tomography; PP: pediatric pulmonologists

^aFirst-level tests will be carried out in PC centers

^b First-level tests will be carried out by respiratory specialists

^C Third-level tests will be carried out immunologists or in reference center

* Spirometry may be performed as part of level 1 when available at the primary care setting