For many pulmonary function laboratories, the initial shock of the pandemic was accompanied by a complete halt in the workflow. Fortunately for most departments, the workflow has returned.

By Stephen Carey, EdD, MS, RRT

The COVID-19 virus has spread around the world in record time. The current pandemic has made the difficulties of asthma worse for many individuals. Worldwide 339 million people have asthma. In the United States, more than 25 million people have asthma.1 For patients with moderate to severe asthma, the risks of getting COVID-19 may mean a worsening of their asthma with increased risk of hospitalization and mortality.2 

Dr William Schaffner, professor, Preventative Medicine and Infectious Disease, Vanderbilt Medical Center, pointed out, the “CDC reports that asthma is listed as a possible risk factor predisposing the individual to a more severe COVID disease.”3 While there is some lingering debate over the risk asthma poses in the COVID-19 population, asthmatic and COVID-19 patients share common symptoms such as an increased work of breathing, dyspnea, and a dry, nonproductive cough.

Challenges to the healthcare system have been numerous and required significant financial resources, training, and innovation. For many pulmonary function laboratories, the initial shock of the pandemic was accompanied by a complete halt in the workflow. Fortunately for most departments, the workflow has returned closer to pre-pandemic levels. Improved procedures, additional time allotted, and new uses of technology are helping bring back a new level of normalcy for many pulmonary function laboratories in the country.  

Asthma Management During COVID-19 

Individuals with asthma are navigating our healthcare system with heightened levels of trepidation, anxiety, and caution. Asthmatics are known to have a higher prevalence for anxiety and depression than the general population.4 As we are aware, anxiety, crying, and extreme emotions can be a potent trigger of asthma.5  Dr Dworski at Vanderbilt Allergy and Asthma Center, states, “Anxiety in our asthmatic patients is a big concern, right now.” 6 

During the COVID-19 pandemic, asthmatic patients are having to contend with many factors which may seem out of their control. Some of the worries and concerns of asthmatics can include medication shortages, perceived lack of effectiveness of alternate medications, and potential exposure to COVID-19 when accessing healthcare services at clinics and hospitals. While we strive to limit our patient’s anxiety, we must be honest and forthright about the challenges of COVID-19 and asthma. Fortunately, with increased knowledge of COVID-19, services for asthmatics are returning with additional levels of support and resources.   

Dr Dworski notes that he spends extra time with patients and “offers counseling to help with anxiety.”7 It’s important at this time to help asthmatic patients find the resources they need to cope with their illness. Complex asthma issues related to sinusitis and similar conditions are referred out to ENT/Rhinology clinic if they are indicated. Dr Dworski comments that patients receiving biologics are continuing their regular shots at their clinic at this time. 

Pulmonary Function Testing is Evolving and Improving

Cleveland Clinic has consistently been a leader and innovator in pulmonary function testing with over 22 testing locations and 40 full-time staff. In a conversation with Dr Bohdan Pichurko, pulmonologist at Cleveland Clinic, identified the extra time needed to accomplish work done to keep both patients and staff safe during the pandemic. Dr Pichurko stated, “Originally, we allotted an extra 30 minutes between our PFT procedures for extended cleaning and staff preparation related to PPE. Now, that our staff has become more proficient and used to the procedures, we have been able to reduce our preparation time from 30 minutes to 15 minutes.”8  

The American Academy of Asthma and Immunology stated, “We know our waiting rooms can be sources of infection as patient congregate, cough, and potentially spread infection.”9 

“The congregation of patients with lung disease may promote the transmission of COVID-19 and should be avoided or managed where possible.”9 Keeping our patients away from other chronic respiratory patients can mean a reduction in the risk of infections and potentially fewer future hospitalizations. 

Many PFT labs are finding success in sending patients home with lower cost, portable PFT spirometers, oximeters, and other devices and combining this with web-based video conferencing. Cleveland Clinic reports utilizing the GoSpiro portable spirometer with Bluetooth connectivity for patients who are at home. When home based PFT testing is combined with web-based video conferencing applications, the technician has an ability to monitor and impact patient effort.  Home-based spirometry is still evolving. The benefits of this type of testing can offer pulmonary function departments a method of requiring fewer disposable resources, PPE, and less exposure for the technologist, and possible increase in efficiencies. 


The COVID-19 virus has challenged healthcare workers to seek new equipment and develop new procedures to overcome the problems presented by the pandemic. Asthma management and pulmonary function testing are rapidly evolving and adopting new forms of technology to improve efficiency of testing while limiting the risk of exposure to both the patient and healthcare providers. By combining home testing and web-based video conferencing patients’ anxiety and risks of exposure may be significantly reduced. 

The anxiety asthmatic patients experience is often a weakness in managing their asthma. Dr Dworski, pulmonologist, Vanderbilt Allergy and Asthma Sinus Center suggested, “Anxiety and fear are common among asthma patients, so I spend extra time with them and offer necessary counseling.”10 Reducing the level of patient anxiety can be approached with regular communication, referrals to appropriate mental health services, and lengthening the time of the patient visit.  

For many pulmonary function laboratories, the workflow has increased to closer to pre-pandemic levels. At the Cleveland Clinic, the work routine in the pulmonary function laboratory has become increasingly more routine. The extra time needed between patients has been reduced from 30 minutes to 15 minutes. These signs of progress can be a step toward returning to our new normal. As we move forward in uncertain times, we can take comfort that our innovation and ability to adapt gives us hope that we can face difficult challenges ahead.


Stephen Carey, EdD, MS, RRT, is assistant professor of Cardiorespiratory Care in the College of Health Sciences at Tennessee State University. For more information, contact [email protected].


  1. World Health Organization. “Asthma Statistics, global prevalence”. 15 May 2020,
  2. CDC. People with Moderate to Severe Asthma. 2020 Sep 11.
  3. Schaffner W, Vanderbilt Medical Center. Department of Preventative Medicine and Infectious Disease, “Re: Questions on asthma”. 29 Aug 2020. Email communication.
  4. Kew K, Nashed M, Valdeep D, Yorke J, Cognitive behavioral therapy (CBT) for adults and adolescents with asthma. Cochrane Database System Rev. 2016 Sep 21;9 (9).
  5. Katon W, Richardson L, McCauley P, The relationship of asthma and anxiety disorders. Psychosom Med, 2004 66 (3).  pp. 349-355
  6. Dworski R, Pulmonologist, Vanderbilt Allergy and Asthma Center. “Re: Questions on asthma”. 29 Sep 2020. Email communication.
  7. Dworski R, Pulmonologist, Vanderbilt Allergy and Asthma Center. “Re: Questions on asthma”. 29 Sep 2020. Email communication.
  8. Pichurko B, Pulmonologist, Cleveland Clinic. Pulmonary Function Laboratory Medical Staff, Personal Interview, 16 September 2020.
  9. McCormack M, Kaminsky D, Advice Regarding COVID-19 for Pulmonary Function Laboratories. American Thoracic Society.
  10. Dworski R, Pulmonologist, Vanderbilt Allergy and Asthma Center. “Re: Questions on asthma”. 29 Sep 2020. Email communication.