SPIROMETRY

What is the design and content of an approved course?

The NIOSH-Approved Spirometry Training Courses incorporate the most recent 2005 American Thoracic Society and European Respiratory Society (ATS/ERS) spirometry testing procedures and interpretation standards. The ATS is the leading medical professional society in the United States that provides evidence-based statements for pulmonary function laboratory standards, testing procedures, and the interpretation of test results.

A. Initial Training Course

The course design must include at least 16 hours of instruction with the following components:

1. At least four hours of formal lectures and/or audio visual material.
2. At least eight hours of small group practical instruction.
3. At least two hours per student devoted to evaluation and testing of the student's spirometry testing skills. Evaluation consists of a written and a practical examination.

The course content should include:

1. Basic physiology of the forced vital capacity maneuver and the determinants of airflow limitation with emphasis on the relation to repeatability of results.
2. Instrumentation requirements including calibration check procedures and sources of error and their correction.
3. Performance of testing including subject coaching, recognition of improperly performed maneuvers, and corrective actions.
4. Data quality with emphasis on repeatability.
5. Actual use of the equipment under supervised conditions.
6. Measurement of tracings and calculation of results.

Information may be presented during a course that is not required by the Cotton Dust Standard. However, this must be in addition to the minimum 16 hours of instruction required by the Standard. Though all NIOSH-approved courses must have the minimal required content in common, the courses vary somewhat in the additional topics that are covered, and some courses are more than 16 hours in length.

B. Refresher Training Course

The course design must include at least 7 hours of instruction. The numbers of lecture, practicum, and examination hours are determined by course directors and approved by NIOSH.

The course content should include:

1. Review of the most recent ATS/ERS testing standards and guidelines,
2. Review of testing contraindications and procedures,
3. Review of technical procedures and instrumentation requirements including calibration check procedures, sources of error, and their correction for both volume displacement and flow measuring spirometers,
4. Review of the effective use of volume-time and flow-volume displays,
5. Review of common spirometry testing errors and applicable corrective actions,
6. Review recommended procedures for proper infection control,
7. Differentiation of lung function patterns (normal, obstructive, restrictive, and mixed disease) using test results and the spirograms.