M.C. Townsend Associates, LLC

NIOSH-Approved Spirometry Training

Requirements/ Recommendations for NIOSH-approved Spirometry Certification

In March, 2016, OSHA promulgated the Respirable Crystalline Silica standard. Along with the Cotton Dust standard, updated in 2019, the OSHA Silica regulation mandates completion of a NIOSH approved spirometry course for technicians performing spirometry as part of the silica medical surveillance exam. See the Silica Medical Surveillance requirements (29CFR1910.1053(i)). In addition, since 2013, OSHA has recommended completion of a NIOSH-approved course as best practice for all occupational spirometry technicians. See OSHA's Guidance on Spirometry Testing in Occupational Health Programs: Best Practices for Healthcare Professionals for details.

NIOSH requires that technicians performing spirometry tests have completed a NIOSH-approved course if clinics want to become "NIOSH-approved Spirometry Clinics" to test coal miners as part of the Coal Workers' Health Surveillance Program (CWHSP). See the Coal Workers' Health Surveillance Program for details.

Certificates of successful completion of a NIOSH-approved spirometry course remain active for 5 years and 7 months grace period from the course date. Certification can be extended in 5 year increments by completing a NIOSH Approved Spirometry Refresher course before the current certificate expires. E.g., if a current course certificate was dated April 1, 2017, the technician would have up to 5 years and 7 months to complete a NIOSH-Approved Spirometry Refresher Course, i.e., until November 1, 2023.

Updated Course Description

The class meets from 8:30-5:30 Eastern Time on Days 1 and 2 and from 8:30-1:00 Eastern Time on Day 3. Students log in 15-20 minutes ahead of the class time each day so that any new technical issues can be resolved.

Before the class is held, an individual 1-1.5 hour Zoom Spirometry Practice tutorial is conducted with each student to make sure that their internet connection is good, to review some basic Zoom tools that are used in the class, and also to teach and have each student demonstrate their ability to perform calibration checks of their spirometer. For these meetings, students must use the computer that they will use for the class and be in the location where they will take the course. Students can take the course at work or at home.

This NIOSH-approved Course is designed for healthcare professionals who conduct spirometric pulmonary function tests and/or interpret test results in industrial and clinical settings. It is one of very few NIOSH-approved courses that has been approved for continuing medical education credits for nurses and respiratory therapists.

This comprehensive NIOSH spirometry course is appropriate for those with no spirometry background as well as for experienced spirometry users. Though the course assumes no prior spirometry experience or knowledge of respiratory physiology, experienced spirometry users always increase their understanding of spirometry and its results by participating in the course. The goal of this course is to teach not only what the requirements and recommendations are for conducting tests and interpreting results, but also why the requirements and recommendations were made.

Using lectures, discussion, and practice sessions, the course presents basic pulmonary pathophysiology, instrumentation requirements, performance of the spirometry test (stressing active coaching), recognition of testing errors and spirometer malfunctions, observed use of the spirometer, measurement of the spirogram, and interpretation of results.

OSHA and NIOSH standards, the 2013 guidance on Spirometry Testing in Occupational Health Programs: Best Practices for Healthcare Professionals, the 2019 and 2005 American Thoracic Society (ATS) Spirometry Official Statements, the 2014 Offical ATS Spirometry Technical Report, the 2022 ERS/ATS Technical Standard on Interpretation Strategies for Routine Lung Function Tests, and the American College of Occupational and Environmental Medicine (ACOEM) Statement on Spirometry in Occupational Health - 2020 are referenced.

In the classes, Dr. Townsend draws on her extensive experience and in-depth knowledge of various spirometers, acquired through extensive consulting with a variety of clients. As she helps clients solve their spirometry problems and identify optimal spirometer configurations, Dr. Townsend obtains new information to share with her students, enabling them to work more effectively with their own equipment and to optimize their spirometry testing skills.

Over half of the class time is devoted to supervised student practice of the techniques that are presented. Individual attention is ensured by maintaining the student/instructor ratio at 6:1 or better. All lectures are given by Dr. Mary Townsend; all practice session assistants are NIOSH-approved and have extensive spirometry experience.

Class size is restricted to 18 students, to maximize student-faculty interaction and to keep the atmosphere informal and conducive to learning. Topics and presentation styles are varied to keep students interested and involved. Breaks are frequent to help students concentrate and remain focused.

Practical and written examinations are given on the last half-day of the course, and a certificate is awarded if performance is satisfactory. NIOSH-Approved Course certificates remain active for 5 years plus a 7-month grace period. Completion of the course is required to obtain continuing education contact hours.

Course Topics

• Review of current OSHA and NIOSH standards, OSHA's 2013 Spirometry Testing in Occupational Health Programs: Best Practices for Healthcare Professionals, the ATS's 2019, 2005, and 2014 Spirometry Official Statements, the ERS/ATS 2022 Spirometry Interpretation Update, and the ACOEM Spirometry in Occupational Health - 2020.
• respiratory defense mechanisms; obstructive and restrictive impairment patterns.
• Spirometry technique and recognizing testing errors.
• Measuring the spirogram: FVC and FEV1, back-extrapolation, BTPS correction, repeatability.
• Interpreting test results: Comparing test results with normal ranges and predicted values; applying scaling factors to obtain Asian-American reference values; evaluating lung function loss over time.
• Types of spirometers: advantages, disadvantages, and how to solve potential problems.
• Spirometer calibration and calibration checks.

Continuing Education

This continuing nursing education (CNE) activity was approved for 19.5 contact hours by the DC Board of Nursing.

Physicians may claim AMA Category 2 credit for attending this class. Category 2 is self-reported and the confirmation email and course certificate can be kept to indicate course attendance. The proportion of total required CME that is allowed to be AMA Category 2 varies by state.

This program has been approved by the American Association for Respiratory Care (AARC) for 21.82 contact hours of Continuing Respiratory Care Education (CRCE) credit.

Course Materials

• A comprehensive course workbook, handouts, NIOSH booklet of spirometry testing errors, and measuring tools will be mailed to each student via USPS Priority Mail before the class. Students need to bring a calculator or cell phone. For international students, please provide a company FedEx account number or credit card number to pay for the cost of shipping abroad.

• Please submit 2-3 test results, with tracings, and cal checks from your spirometer prior to the class, if possible. The reports and tracings will be critiqued and feedback will be provided as time permits.

Virtual Course Dates

Registration Information

• all course materials, including comprehensive workbook and reference materials
• OSHA's 2013 Spirometry Testing in Occupational Health Programs: Best Practices for Healthcare Professionals
• continuing education credit
• spirogram measuring tools