A number of leading pulmonary physicians from around the world have expressed and continue to express concerns about the false negative and false positive results that occur because of poor quality pulmonary function tests. Poor quality testing is not only a waste of resources but more importantly it leads to incorrect diagnoses which leads to improper treatment plans, unnecessary drug prescriptions, unnecessary office visits, unnecessary testing and wasted time.
Why are there problems with test quality?
Performing pulmonary tests requires specialized equipment that measures inspiratory and expiratory air flows, volumes and gas concentrations. This equipment requires regular calibration and maintenance to work properly and if this isn’t done, test results can be inaccurate.
The staff performing pulmonary testing need to have a good knowledge of lung anatomy and physiology, and the effects that different lung disorders have on lung function. In addition staff need to have extensive knowledge of the testing standards and test equipment. When testing staff have an inadequate education then testing can be performed improperly and test results can be inaccurate.
Most importantly, pulmonary testing requires a patient’s cooperation, effort and the ability to follow test directions. Without this test results can also be inaccurate.
Who’s responsible for test quality?
Primarily it’s the individual testing sites. With just one exception there is no national or state-level oversight of Pulmonary Function testing in the USA. The Joint Commission, which regularly inspects hospitals, may inspect a Pulmonary Lab as part of a routine visit but this is highly variable and the details of this inspection are often left to individual surveyors.
Note: The one exception is the Coal Worker’s Health Surveillance Program which is run by NIOSH. This program requires certification of the testing facilities and their staff before they are allowed to perform spirometry.
Many states require credentialing of the staff that work in hospital labs, but the specifics of this vary from state to state. The credentials that are most specific to Pulmonary testing are CPFT (Certified Pulmonary Function Techician) and RPFT (Registered Pulmonary Function Technician) but these are required in only a small number of states. More often CRT (Certified Respiratory Therapist) or RRT (Registered Respiratory Therapist) credentials are required but in at least 10 states no credentials are required at all.
There are also no requirements for staff that perform spirometry in doctor’s offices and clinics, nor is there any national or state-level oversight of this testing. For this reason, the staff tasked with performing spirometry in offices and clinics are often Medical Assistants with limited education and training. There is an office spirometry certification program run by the American Association of Respiratory Care (AARC) but this is voluntary.
Despite a lack of governmental oversight most of the staff members that you encounter for pulmonary testing are usually trying to do it well. People don’t go into the medical field without having concern and compassion for others. It’s also important to remember that because pulmonary testing requires patient cooperation, effort and ability, the responsibility for test quality has to be shared between the patient and the testing site.
What should you expect?
If you are undergoing Pulmonary function testing you should expect that it can be stressful; that it can make you short of breath, uncomfortable, and possibly even claustrophobic; and that you will need to breathe in ways that can be unexpected and unusual but you should also expect:
- you will be given a clean mouthpiece and noseclip
- you will be given clear instructions about how to perform the tests
- you will be given positive encouragement by the staff performing the test
- you will be given positive corrections and suggestions by the staff performing the tests
- that sufficient time will be given to perform each test several times
- that the staff can and will answer questions about your tests and the results
You should be concerned about your test quality if:
- you are not given a mouthpiece or noseclip
- the staff performing your tests are abrupt, rude, discourteous or impatient
- the staff performing your tests give you unclear or conflicting instructions
- you aren’t given sufficient time to perform the tests properly
- the staff performing your tests are unwilling or unable to answer your questions about your tests and results
- the testing equipment or testing room is poorly maintained, dusty or dirty
If you are concerned with your test quality what should you do?
The person most likely to share your concerns is the physician that ordered the tests. Most physicians will expect that you won’t like pulmonary function so it is important to be specific. Was it the staff attitude, the test instructions, the amount of time you were given, the equipment or the facilities? If you can make your concerns clear, your physician will likely share them and should in turn bring them to the attention of the proper administrator or lab manager. Physician complaints are usually taken very seriously by anyone who receives them. Realistically a single physician complaint may not bring about immediate changes but if there are enough of them, something will likely be done to correct the problems.
It is important that we advocate for our own medical care and that we all learn about the medical conditions that affect us and about the medical tests and procedures we need to undergo. The resources needed for any type of medical testing (money, staff and space) are always limited, however. The concerns that you share about the quality of your testing can improve the utilization of these resources and help direct these resources to where they are needed the most.
PFT Patient by Richard Johnston is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.