Vol. 19 •Issue 22 • Page 21
Do You Need A Pulmonary Function Credential?
Most of us take pulmonary function data at face value when we see them on a chart. We may think about the patient’s effort, of course, but do we ever stop to consider how the data were collected? Do we look at which standard was used to determine the values or ponder the competency of the practitioner conducting the test?
If we dig deep into these issues, we find that not all pulmonary function results or practitioners doing their testing are created equally.
The National Board for Respiratory Care (NBRC) awards two credentials for pulmonary function testing: the Certified Pulmonary Function Technologist (CPFT) and the advanced Registered Pulmonary Function Technologist (RPFT).
In addition, there are practitioners who are credentialed as a Certified Cardiopulmonary Technologist (CCPT) with a specialty in Pulmonary Technology. They received this credential from either the National Society for Cardiovascular and Pulmonary Technology (NSCPT) or from the National Board for Cardiovascular and Pulmonary Credentialing (NBCPC).
These therapists were recognized by the NBRC in July 1984 as CPFTs. It is good to remember they are still out there, because occasionally some will present their credentialing certificates from one of these organizations.
Enough Confusion Already
As if this isn’t confusing enough, the American Thoracic Society (ATS) and the European Respiratory Society (ERS) formally agreed in 2005 to a set of guidelines that are similar to those established by the National Institute for Occupational Safety and Health (NIOSH) for spirometry technician training standards. Yes, you read that correctly: a spirometry technician. You can be awarded a credential by NIOSH as a Certified Spirometry Technician (CST).
To be credentialed by NIOSH, you must complete a 16-hour training program that includes at least four hours of formal lectures and/or audio visual material, eight hours of small group practical instruction and two hours per student of evaluation and testing.
Among the subject areas covered are basic physiology of a forced vital capacity (FVC) maneuver with an emphasis on reproducibility of the results; equipment maintenance and calibration procedures; and an overview of measurement tracings and calculation of results.
NIOSH developed this course to meet the Occupational Safety and Health Administration (OSHA) requirements set forth as part of the Cotton Dust Standard. The Cotton Dust Standard neither requires any prerequisite training or continuing education nor a refresher course.
It does lay out another set of specific guidelines and the minimum requirements for testing and equipment. Specifically, the Cotton Dust Standard discusses the measurement and equipment requirements for a forced expiratory volume in one second (FEV1). Though interestingly, this is not mentioned in the required minimum NIOSH training.
An FVC is specifically discussed in the NIOSH requirements. Granted, it is a technical point, but wouldn’t you want your tester to know the difference? Remember these people are not required to have any previous or subsequent training in health care. The ATS/ERS guidelines do go into greater detail about lung volumes and also recommend a refresher course every three to five years in their guidelines.
Why are we even discussing this? Because there are health care providers who are listing the NIOSH CST behind their name and it is being used as the basis for the reliability of office-based and outpatient spirometry testing. There are even those who are arguing that the NIOSH training standards are excessive and unnecessary for outpatient testing.
These requirements are quite different from what the NBRC asks of its applicants. The current requirements for the CPFT exam are that the applicant must be at least 18 years old and meet one of several requirements. Among these are they must be have at least an associate degree from a respiratory therapy educational program or from an approved pulmonary function technology educational program or be a CRT or RRT.
Or the applicant must complete 62 semester hours of college credits in biology, chemistry and mathematics and at least six months of clinical experience in the field of pulmonary. Or be a high school graduate with two years experience in PFTs under medical direction.
The requirements for a RPFT are a little easier to understand. You must be a CPFT. The only caveat with this one is that individuals who were credentialed through the CCPT examination with a specialty in Pulmonary Technology offered by the NSCPT or by the NBCPC are eligible for the RPFT examination.
These practitioners must provide a copy of their credential with their application.
The NBRC reports that 160 individuals took the CPFT examination during the first half of 2006. A total of 91 of these individuals successfully passed the test; 18 CPFTs successfully achieved the advanced RPFT credential. That is about average when you compare the number to last year’s numbers. In 2005, about 321 candidates sat for the CPFT examination and 194 and successfully completed the exam.
In addition, 34 CPFTs passed the advanced RPFT board and were awarded the credential. According to the NBRC, there are more than 11,769 CPFTs and 4,004 RPFTs credentialed to date.
Definition of Spirometry Debated
Adding further fuel to these credentialing fires: some medical professionals are arguing about the definition of “spirometry.” Does a “basic study” include only an FVC? Or are all lung volumes and values included? That would include a diffusion capacity (DLCO). And they argue over whether a practitioner can perform the necessary maneuver as a basic test. Some argue that there is no difference in the actual procedure if they administer a bronchodilator and then repeat it. They are correct. The actual buttons they push are the same. But is this safe?
The American Association for Respiratory Care and the National Lung Health Education Program are trying to establish a uniform set of standards that will apply to pulmonary function testing, but the current status of these efforts is unknown.
The question has to be asked: Will they be able to reach a consensus, implement these standards and have them accepted universally?
Maybe you need to look at that PFT again when you review the chart. Perhaps we need to start asking questions about where the results came from and how they were derived?
Margaret Clark is a Georgia practitioner.