RT Journal Article
SR Electronic
T1 Aerosol Generation During Peak Flow Testing: Clinical Implications for COVID-19
JF Respiratory Care
FD American Association for Respiratory Care
SP 1291
OP 1298
DO 10.4187/respcare.08731
VO 66
IS 8
A1 Yosuf W Subat
A1 Siva Kamal Guntupalli
A1 Pavol Sajgalik
A1 Matthew E Hainy
A1 Keith D Torgerud
A1 Scott A Helgeson
A1 Bruce D Johnson
A1 Thomas G Allison
A1 Kaiser G Lim
A1 Alexander S Niven
YR 2021
UL http://rc.rcjournal.com/content/66/8/1291.abstract
AB BACKGROUND: Peak flow testing is a common procedure performed in ambulatory care. There are currently no data regarding aerosol generation during this procedure. Given the ongoing debate regarding the potential for aerosol transmission of SARS-CoV-2, we aimed to quantify and characterize aerosol generation during peak flow testing.METHODS: Five healthy volunteers performed peak flow maneuvers in a particle-free laboratory space. Two devices continuously sampled the ambient air during the procedure. One device can detect ultrafine particles 0.02–1 μm in diameter, while the second device can detect particles 0.3, 0.5, 1.0, 2.0, 5.0, and 10 μm in diameter. Five different peak flow meters were compared to ambient baseline during masked and unmasked tidal breathing.RESULTS: Ultrafine particles (0.02–1 μm) were generated during peak flow measurement. There was no significant difference in ultrafine particle mean concentration between peak flow meters (P = .23): Respironics (1.25 ± 0.47 particles/mL), Philips (3.06 ± 1.22), Clement Clarke (3.55 ± 1.22 particles/mL), Respironics Low Range (3.50 ± 1.52 particles/mL), and Monaghan (3.78 ± 1.31 particles/mL). Ultrafine particle mean concentration with peak flow testing was significantly higher than masked (0.22 ± 0.29 particles/mL) and unmasked tidal breathing (0.15 ± 0.18 particles/mL, P = .01), but the ultrafine particle concentrations were small compared to ambient particle concentrations in a pulmonary function testing room (89.9 ± 8.95 particles/mL).CONCLUSIONS: In this study, aerosol generation was present during peak flow testing, but concentrations were small compared to the background particle concentration in the ambient clinical environment. Surgical masks and eye protection are likely sufficient infection control measures during peak expiratory flow testing in asymptomatic patients with well controlled respiratory symptoms, but COVID-19 testing remains prudent in patients with acute respiratory symptoms prior to evaluation and peak expiratory flow assessment while the community prevalence of SARS-CoV-2 cases remains high.