Aerosol Production by Children Performing Spirometry and Implications During a Pandemic

Introduction

As the COVID-19 pandemic persists and eradication of SARS-CoV-2 seems unlikely, children must resume ongoing medical care for their underlying asthma, which routinely includes obtaining pulmonary function testing, a potentially aerosol-generating procedure. In contrast to adults, most children, when infected, are either asymptomatic or report mild symptoms indistinguishable from the common cold.¹ It has become crucial to identify aerosol-generating procedures to ensure the safety of health-care workers and patients during the SARS-CoV-2 pandemic. Pulmonary function testing, most commonly spirometry, is a routine diagnostic test completed by many patients during their pulmonary clinical evaluations. Pulmonary function testing and spirometry are not currently listed as aerosol-generating procedures by the Centers for Disease Control and Prevention.²

However, the American Thoracic Society and the American Academy of Asthma, Allergy & Immunology recognize that pulmonary function testing has the potential to generate aerosols.^3–5 However, studies that investigated the production of aerosols during pulmonary function testing are lacking, which makes it difficult to advise on appropriate personal protective equipment and infection control strategies. Given that aerosol-generating procedures are associated with an increased risk of transmission to health-care workers,⁶ it is crucial to identify whether routine spirometry procedures generate aerosols. This remains true despite many health-care institutions requiring SARS-CoV-2 vaccines as new variants continue to emerge.⁷ We aimed to address this knowledge gap by quantifying the aerosol load and particle …