Table 1.

Issues related to safely performing pulmonary function test and proposed solutions by National/International Organizations.

Issue	Proposed solutions
	CHINESE TASK FORCE5	SPLF9	ATS6	SPP9, 16	SEPAR/AEC/AET/SEAIC10	ANZSRS/ TSANZ7, 14	ITS11	NEBRASKA	CLEVELAND21	SUNEUMO18	BTS/ARTP12	ERS17	ITS/AIPO19	IRS/SIP20
	04/03/2020	17/03/2020	20/03/2020	23/03/2020	25/03/2020	25/03/2020	30/03/2020	01/04/2020	13/04/2020	13/04/2020	27/04/2020	09/05/2020	09/05/2020	12/05/2020
Eligible patients	U/ET tests for Dx of current illness COPD/Asthma: postpone or use PFM	U tests for: - PRE-OP - CA - clinical decision	U/ET tests for immediate treatment	U tests for: - PRE-OP - CA - Dx - therapies	Avoid PFT in patients with respiratory Sx unless necessary	Afebrile Asymptomatic	U tests for: - RALC O/P - CF I/P - PRE-OP - ID	ET tests for: - LTP - PRE-OP - CF Pts - IST - Asymptomatic	ET tests for: - LTP - CTX surveillance - Surgery - ILD - PAH	ET tests for: - PRE-OP for LR, CS, OS - ILD Dx - PneumoTox Dx - ID (tested first)	ET tests for: - LTC - CA I/P - PRE-OP for US - ID (tested first)	U/ET tests for immediate Dx	U/ET tests for: - PRE-OP TAS - immediate Dx COPD/Asthma: postpone or use PFM	ET tests for: - PRE-OP TAS - LTPs - COPD Dx - Asthma Dx - ILD (Dx, F/U, drug Rx) - ID (tested first)
Post- COVID-19 pneumonia	- Normal BT > 3d - Sx improvement - Imaging improvement −2 consecutive negative swabs										12-wks after discharge	30d post-infection	30d post-infection dedicated PFT lab	Pts with Sx
Social Distancing/ Prevention	Pts wear mask	Pts wear mask Hand hygiene		Pts wear mask Pts alone/one caregiver	Hand hygiene Pts wear mask if have Sx Pts sit >1 m Pts alone/one caregiver		Pts remain in the car RP phone to pts to come for PFT Pts sit >2 m Hand sanitizer	Pts wear mask			Pts sit >2 m	Pts wear mask Pts sit >2 m Hand hygiene Use gloves Pts alone/one caregiver	Pts wear mask and gloves Pts alone/one caregiver	Pts wear mask Hand hygiene Pts alone/one caregiver
Trace suspicious cases	Risk assessment questionnaire BT detection			Risk assessment questionnaire BT detection		BT detection	Risk assessment questionnaire	Risk assessment questionnaire 48−72 h before and the day of the test	Risk assessment questionnaire	Risk assessment questionnaire BT detection	Hand sanitizer BT detection	Risk assessment questionnaire BT detection	Risk assessment questionnaire Evaluate swab 48−72 h before	Risk assessment questionnaire BT detection Evaluate swab 48−72 h before
HCWs protection	PPE: - mask - eye protection - gloves Hand hygiene before/after gloves use Attention to medical staff health	PPE: - surgical mask - eye protection - gloves - gown	PPE Hand hygiene	PPE: - N95/FFP2 (change q4h-q6h or if wet) - eye protection - nitrile gloves - gown - shoe protector	PPE: - FFP2/FFP3 - gloves - eye protection - gowns	PPE	PPE: - FFP2	PPE: - N95 mask - eye protection - gowns - gloves Hand hygiene	PPE: - surgical mask - eye protection - gloves If aerosolization: - gown - gloves - eye protection - N95 - powered air purifying	PPE: - N95/FFP-mask - gloves - eye protection - cap and hair up - eye protection - gowns	PPE: - FFP3 - eye protection Hand hygiene	PPE: - FFP2/FFP3 - gloves - eye protection Hand hygiene	PPE: - FFP3/FFP2 - eye protection - gloves	PPE: - FFP2 - eye protection - gowns - gloves
Testing and equipment	1 exam at time Disposable BVF BVF total resistance <1.5 cmH20 at a flow rate of 14 L·s-1 Technician sit in the same directionof pts Separate test/admin area Edu program/Telematic report	Perform the exam inside a plethysmography booth Recalibrate the equipment after decontamination		Disposable BVF BD test: disposable expansion chambers	Separate test/ administrative area Disposable BVF Disposable nose-clips Technician sit in the same direction of pts Informational posters	Disposable BVF BD test: pts’ salbutamol inhaler or a single-use inhaler Portable individual patient dedicated spirometers			Disposable BVF		Disposable BVF	Disposable BVF with minimum efficiency for high expiratory flow of 600–700 L/min Single use consumables Telemedicine for high-risk O/P Recalibrate the equipment after decontamination Separate test/admin area	1 exam at a time Disposable BVF Total resistance of BVF and tube of spirometer should <1.5 cmH2O·L-1·s-1 Disposable nose-clips Technician sit in the same direction of pts Recalibrate the equipment after decontamination Edu program Separate test/admin area	Disposable BVF > 99% efficiency for HEF of 600–700 L/min Disposable nose-clips BD test: pts’ salbutamol inhaler or a single-use inhaler or aerochamber® Separate test/admin area
Room ventilation	160 L/s for each pt for hour if natural ventilation 12 ACH for hour if negative room Turn off the A/C	15 min open windows closed doors		Ventilated rooms to avoid recirculation	Ventilated rooms to avoid recirculation			Room closed for 1 h after the procedure			30 min for isolation room with 10−12 ACH 60 min for side room with 6 ACH	15 min open windows closed doors Negative pressure room for high-risk pts NO HEPA filters	15 min open windows closed doors
Environment/surfaces cleaning	Clean external instruments twice with 75% ethanol for 3min Sanitize the environment BID UV light room decontamination for >30 min	Clean equipment/surfaces	Wiping down surfaces with appropriate cleaners	Clean equipment/surfaces	Minimal furniture Clean equipment/surfaces Cleaning solutions: Alcohol 60−70 °, 0.5% hydrogen peroxide or disposable wipes, hypochlorite 0.1%	Minimal furniture Clean equipment/surfaces	Clean contact parts with appropriate wipes		Super Sani-Cloth germicidal disposable wipes (PDI, Woodcliff Lake,NJ) for hard surfaces Sani-Cloth AF3 for glass and other clear surfaces		Clean contact parts with appropriate wipes (alcohol/Clinell wipes) Cleaning solutions: - ethanol >70% - sodium hypochlorite at least 0.21%	Regular equipment cleaning protocols UV light or ozone room decontamination at intervals	Clean equipment/surfaces UV light or ozone room decontamination at intervals Sanitize the environment BID	Clean equipment/surfaces Sanitize according to ecdc indications UV light, ozone/hydrogen room decontamination
Wait time between patients				60 min			30 min	60 min			30−60 min	30−60 min

List of Abbreviations: 30d: 30 days; A/C: air conditioning; ACH: air changes per hour; Admin: administrative; AET: Asociacion de Especialistas en Enfermeria del trabajo; AEC: Asociacion de Enfermeria Comunitaria; AS: Asymptomatic; ARTP: Association for Respiratory Technology and Physiology; ATS: American Thoracic Society; ANZSRS: Australian and New Zealand Society of Respiratory Science Ltd; ANZSRS: Australian and New Zealand Society of Respiratory Science Ltd; BD-Test: Post Bronchodilator test; BID: twice a day; BT: Body Temperature; BTS: British Thoracic Society; BVF: Bacterial/viral filter; CA: Cancer Patients; CF: Cystic fibrosis; CLEVELAND: Respiratory Institute Cleveland Clinic; COPD: Chronic Obstructive Pulmonary Disease; CS: Cardiac Surgery; CTX: chemotherapy; Dx: diagnosis; ecdc: European Centre for Disease Prevention and Control; Edu program: Educational program; ERS: European Respiratory Society; ET: essential; FFP: filtering face piece; F/U: follow up; HCWs: Health Care Workers; HEF: High Expiratory Flow; HEPA: High Efficiency Particulate Air filter; I/P: inpatients; ID: Immunocompromised patients; ILD: Interstitial Lung Diseases; IRS/SIP: Italian Respiratory Society/Società Italiana di Pneumologia; IST: Immunosuppressive Therapies; ITS: Irish Thoracic Society; ITS/AIPO: Italian Thoracic Society/Associazione Italiana Pneumologi Ospedalieri; LR: Lung Resection; LTC: long-term conditions; LTP: Lung Transplant Patients; Min: minutes; O/P: outpatients; OS: Oncological Surgery; PAH: Pulmonary Arterial Hypertension; PFM: Peak Flow Meter; PFTs: Pulmonary Function Tests; PneumoTox: Pneumotoxicity; PPE: personal protective equipment; PRE-OP: Preoperative patients; Pt/Pts: patient/patients; q4h: every 4 h; q6h: every 6 h; RALC: Rapid Access Lung Cancer Patients; RP: Respiratory Physiologist; SEIAC: Spanish Society of Allergy and Clinical Immunology; SEPAR: Spanish Society of Pneumology and Thoracic Surgery; Sx: symptoms; SPLF: Société de Pneumologie de Langue Française; SPP: Sociedade Portuguesa de Pneumologia; SUNEUMO: Sociedad Uruguaya de Neumologia; TAS: Thoraco-Abdominal Surgery; TR: Telematic Reports; TSANZ: Thoracic Society of Australia and New Zealand; U: urgent; US: Urgent Surgery; UV: ultraviolet; Wks: weeks.