An ad hoc committee of the National Academies of Sciences, Engineering, and Medicine (National Academies) will conduct a study to review the latest published research and science and produce a report addressing best practices and known limitations in the use of pulmonary function testing procedures and devices to measure pulmonary or lung function in connection with SSA disability evaluations, including:
1. Describing the current practice landscape for the measurement of an individual’s pulmonary or lung function, particularly with regard to spirometry testing, or how well air is moved into and out of the lungs, and diffusing capacity of the lungs for carbon monoxide (DLCO) testing, or how well carbon monoxide diffuses across cell membranes into the blood; and
2. Answering the following questions based on published evidence (to the extent possible) and professional judgment (where published evidence is lacking), and noting any differences between the adult and pediatric population, where applicable:
a. What, if any, changes have been accepted as best practices in the provision of spirometry testing within the last 15 years?

b. What, if any, recent changes have been accepted as best practices in the provision of DLCO testing within the last 15 years?

c. For both spirometry and DLCO testing, what is the current landscape of access to such testing and the feasibility of administering such testing, among various populations, providers, and locations in the United States?

d. For both spirometry and DLCO testing, considering the testing equipment that is currently in use (generally, equipment that was produced within the last 10 years):
i. What types of tracings (e.g., flow-volume, volume-time, concentration-volume) are typically available for the test administrator to review during the test, and which, if any, are typically available to be included in printed or exported reports?
ii. For tracings that are available for the test administrator to review, how many tracings are generally available for inclusion in the printed or exported report?
iii. What other testing indicators or outputs important to determining the accuracy and reliability of testing are generally available to be included in a printed or exported report?
e. For both spirometry and DLCO testing, how essential is SSA review of legible tracings of the associated breath maneuvers included in the test report when making a determination that the testing represents an accurate and reliable evaluation of an individual’s pulmonary functioning? If legible tracings are essential, what types of tracings and number of maneuvers are needed for each type of test?
f. For spirometry testing, how does the test administrator determine an individual performed the expiratory maneuver with maximum effort and what are the accuracy and reliability implications when an individual either does not perform the maneuver with maximum effort or does not produce a test tracing with a sharp takeoff, rapid rise to peak flow, smooth contour, plateau for at least 1 second, and total duration of at least 6 seconds?
g. For spirometry testing, what factors impact effectiveness in ensuring testing accuracy in the current SSA acceptability criteria in 3.00E and 103.00E compared with the acceptability, usability, and repeatability criteria for FEV1 and FVC testing contained in the American Thoracic Society’s Standardization of Spirometry 2019 Update?
h. For DLCO testing, what are the accuracy and reliability implications when an individual is unable or unwilling to produce two acceptable DLCO measurements within (1) 3 mL CO (STPD)/min/mmHg of each other, (2) 2 mL CO (STPD)/min/mmHg of each other, or (3) 10 percent of the highest value?
i. For DLCO testing, what are the accuracy and reliability implications when the volume of inhaled gas (VI) by an individual during the DLCO maneuver is less than 1) 85 percent or 2) 90 percent of their current forced vital capacity (FVC)?
j. For DLCO testing, what are the accuracy and reliability implications of a breath-hold time less than 8 or greater than 12 seconds?
k. For DLCO testing, what factors impact effectiveness in ensuring testing accuracy in the current SSA acceptability criteria in 3.00F compared with the acceptability, repeatability, and quality control criteria for DLCO testing contained in the 2017 European Respiratory Society/American Thoracic Society standards for single-breath carbon monoxide uptake in the lung?
l. What are the most widely acceptable and commonly used alternatives to spirometry and DLCO testing for the measurement of ventilation of the lungs and gas diffusion in the lungs and what special considerations might these techniques present in the context of disability evaluation?
The report will include findings and conclusions but not recommendations.