Spirometry Training Program

What is a NIOSH-approved spirometry training course?

The Cotton Dust Standard [29 CFR 1910.1043external icon], promulgated by the Occupational Safety and Health Administration (OSHA), gives the National Institute for Occupational Safety and Health (NIOSH) the responsibility to approve spirometry training courses for individuals who administer spirometry tests to employees exposed to cotton dust.

In addition to the Cotton Dust Standard, two other regulations now require NIOSH-approved spirometry training: OSHA’s Respirable Crystalline Silica Standards for general industry and maritimeexternal icon and constructionexternal icon and NIOSH’s Specifications for Medical Examinations of Coal Minersexternal icon.

Note: Facilities performing spirometry testing on coal miners or coal mine contractors (surface and underground) must apply for Spirometry Facility Approval.

Learn more about the NIOSH Spirometry Training Program here.

Current Guidance for Spirometry Testing

What's New
  • Special Notice: NIOSH-approved Course Certificate NEW 2021 Extension

The NIOSH Spirometry Training Program is extending NIOSH-approved Training Course certificates with expiration dates in calendar year 2021 to 2022. For example, if a NIOSH-approved certificate expires on June 18, 2021, the new expiration date is now June 18, 2022.

As class sizes are limited, it is important to sign up for available refresher courses early. NIOSH-approved live virtual and in-class refresher courses are listed on the Spirometry Course Schedule. Check with active sponsors to sign up for waiting lists.

  • 3-day Initial Virtual Course

A live NIOSH-approved Virtual Initial Course is scheduled for December 6-8, 2021. Please contact Course Sponsor #101.

Important Reminder

NIOSH-approved Spirometry Training Program Sponsors, faculty, students, and facilities administering spirometry testing are reminded that 3-liter syringes and calibration checks (verifications) are necessary for all spirometer technologies and models according to American Thoracic Society and European Respiratory Society (ATS/ERS) 2019 technical guidelinesexternal icon and the Occupational Safety and Health Administration’s (OSHA’s) Cotton Dust Standardexternal icon (CDS). In addition, both documents outline specifications for real-time graphic sizes for volume–time and flow–volume curve displays. See web links for further details.

Syringes and calibration checks

The ATS/ERS 2019 Technical Statement Standardization of Spirometry 2019 Updateexternal icon provides detailed information about 3-liter syringes and calibration checks: “Calibration verifications must be undertaken at least daily using a 3-L syringe cycled at least three times to give a range of flows varying between 0.5 and 12 L/s (with 3-L injection times between 0.5 and 6 s).”

“Calibration verifications must be undertaken daily, or more frequently if specified by the manufacturer. Precalibrated spirometers cannot be recalibrated by the operator but must still undergo a calibration verification. Manufacturers must specify the action to be taken if a precalibrated device fails the calibration verification. Spirometry software must include the ability to generate a report of calibrations that includes the results of all verifications, the number of failed calibration verifications in each session, and the changes in calibration factors.”

The CDS Appendix D – Pulmonary Function Standards for Cotton Dust Standard 1910.1043external icon states that “calibration checks of the volume accuracy of the instrument for recording FVC and FEV1 shall be performed daily or more frequently if specified by the spirometer manufacturer, using a 3-liter syringe.”

Real-time graphic displays during spirometry testing

The ATS/ERS 2019 Technical Statement Standardization of Spirometry 2019 Updateexternal icon clearly states specifications for graphic displays during testing: “For optimal quality control, both volume–time and flow–volume real-time displays are required, and operators must visually inspect the performance of each maneuver for quality assurance before proceeding with another maneuver. For the flow–volume graph, expiratory flow must be plotted upward, and expiratory volume must be plotted toward the right. A 2:1 aspect ratio must be maintained between the flow and volume scales; that is, 2 L/s of flow and 1 L of volume must be the same distance on their respective axes.”

The CDS App D – Pulmonary Function Standards for Cotton Dust Standard 1910.1043external icon requires that equipment purchased after May 14, 2020 “shall provide during testing a paper tracing or real-time display of flow versus volume and volume versus time for the entire forced expiration. Such a tracing or display is necessary to determine whether the worker has performed the test properly. Flow-volume and volume-time curves must be stored and available for recall. Real-time displays shall have a volume scale of at least 5 mm/L, a time scale of at least 10 mm/s, and a flow scale of at least 2.5 mm/L/s, when both flow-volume and volume-time displays are visible.”

Page last reviewed: February 26, 2020