Sheikh Sadiyah, Hamilton Fergus W, Nava George W, Gregson Florence K A, Arnold David T, Riley Colleen, Brown Jules, Reid Jonathan P, Bzdek Bryan R, Maskell Nicholas A, Dodd James William
Bristol Aerosol Research Centre, School of Chemistry, University of Bristol, Bristol, UK.
Department of Infection Science, North Bristol NHS Trust, Bristol, UK
Thorax. 2022 Mar;77(3):292-294. doi: 10.1136/thoraxjnl-2021-217671. Epub 2021 Nov 2.
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 FE 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/cm), followed by unfiltered peak flow (0.37-0.76 particles/cm). 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. FE 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.
肺功能测试对于呼吸系统疾病的诊断和监测至关重要。关于测试过程中是否会产生潜在传染性气溶胶尚存在不确定性，且关于降低工作人员风险的缓解策略的数据有限。健康志愿者和肺部疾病患者接受了标准化肺活量测定、峰值流量和用力呼气量评估。使用空气动力学粒径分析仪和光学粒径分析仪对气溶胶数浓度进行采样。将测得的气溶胶浓度与呼吸、说话和自主咳嗽时的情况进行比较。缓解策略包括使用标准病毒过滤器和通常用于运动测试的全面罩（以减轻诱发咳嗽）。从33名健康志愿者和10名肺部疾病患者中收集了147次测量数据。咳嗽时的气溶胶数浓度最高（1.45 - 1.61个颗粒/立方厘米），其次是未过滤的峰值流量（0.37 - 0.76个颗粒/立方厘米）。在峰值流量测试中添加病毒过滤器可使气溶胶排放量减少10倍，且不影响测试结果。平均而言，患者咳嗽产生的气溶胶比标准肺活量测定（使用过滤器）多22倍，健康志愿者咳嗽产生的气溶胶多56倍。用力呼气量测量产生的气溶胶可忽略不计。心肺运动测试（CPET）面罩在呼吸、说话和咳嗽时可显著减少气溶胶排放。肺功能测试产生的气溶胶比自主咳嗽少。CPET面罩可用于减少诱发咳嗽产生的气溶胶排放。标准病毒过滤器足够有效，可使指南将肺功能测试从产生气溶胶的操作列表中移除。
