M.C. Townsend Associates, LLC

Virtual NIOSH-Approved Spirometry Refresher

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 also 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 (plus a 7 month 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, 2022.

Along with their registration form, students must provide a copy of their most recent NIOSH-Approved Spirometry Course certificate to establish eligibility for the Refresher course.

Updated Course Description

The class meets from 8:30-5:30 Eastern Time. Students log in 20-30 minutes ahead of the class time so that any new technical issues can be resolved.

Before the class is held, an individual 45-60 minute Zoom Practice meeting is conducted with each student to make sure that their internet connection is good and to review some basic Zoom tools that are used in the class. 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 so that internet connections can be checked. Students can take the course at work or at home.

The U.S. Occupational Safety and Health Administration (OSHA), the American College of Environmental and Occupational Medicine (ACOEM), the American Association of Occupational Health Nurses (AAOHN), and the American Thoracic Society (ATS) all require or recommend periodic training that reviews spirometry technique and updates technicians on changes in the field of pulmonary function testing and pertinent regulations. This NIOSH-Approved Refresher Course is designed to provide that review for health professionals who conduct and/or interpret spirometry tests in industrial and clinical settings.

The course briefly reviews the pathophysiology of obstructive and restrictive impairments and emphasizes correct performance of spirometry and the effects of technical errors and spirometer malfunctions on test results and interpretations of repsiratory impairment. Students practice recognizing testing errors, using problem graphs from quality control samples. The goal of the course is not only to review what the recommendations and requirements are for conducting tests and interpreting results, but also why the recommendations and requirements were made.

In the classes, Dr. Townsend draws on her extensive experience and in-depth knowledge of various spirometers, acquired through on-going 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.

OSHA's standards and the 2013 Guidance on Spirometry Testing in Occupational Health Programs: Best Practices for Healthcare Professionals, the 2019 and 2005 ATS/ERS Spirometry Official Statements, the 2022 ERS/ATS Technical Standard on Interpretation Strategies for Routine Lung Function Tests, and the ACOEM Statement on Spirometry in Occupational Health - 2020 are reviewed. Current recommendations are presented for spirometer calibration checks and for interpretation of results as normal or indicating obstructive or restrictive impairment.

NIOSH asks that each student submit a sample of graphs to be critiqued for technical quality prior to the course.

Class size is limited to maximize student-faculty interaction and to keep the atmosphere informal and conducive to learning. Topics are varied to keep students interested and involved. Breaks are frequent to help students concentrate and remain focussed.

Since many students have not performed spirometry tests recently due to COVID, small groups are used to practice subject coaching. All lectures are given by Dr. Mary Townsend; all practice session assistants are experienced in spirometry.

A certificate extending NIOSH certification by 5 years is awarded upon completion of the course.

Course Topics

• Spirometry technique, testing errors, and interpretation following OSHA 2013 Best Practices, ATS/ERS 2005 and 2019, and ERS/ATS 2022 Spirometry Updates.
• Interpreting results as obstructive, restrictive, or mixed impairment patterns, using OSHA Best Practices and ATS/ERS Interpretation Guidelines.
• Review OSHA's standards and 2013 Guidance on Best Practices for occupational spirometry testing.
• Review spirogram measurements, and effects of ambient temperature.
• Evaluate test validity using real-life problem graphs from quality control samples.
• Types of spirometers: advantages, disadvantages, and potential problems.
• Spirometer calibration and mandatory calibration checks.

Continuing Education

This continuing nursing education (CNE) activity was approved for 8.0 contact hours by the DC Board of Nursing.

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

Course Materials