Provision of Pulmonary Function Testing

In order to maintain the maximum number of Operationally effective Military divers , the Authority is required to provide Pulmonary Function Testing (PFT). This test, when required, is used to inform decision-making regarding fitness to undertake diving training and maintaining / returning Military divers to full diving fitness.

An outline of the standard testing for divers includes, as a minimum but not limited to, the following:

a. Medical history questionnaire;

b. Targeted physical examination where applicable;

c. Flow volume loop;

d. Plethysmography

e. Gas transfer;

f. Exercise spirometry;

g. β2 agonist reversibility.

The current Association of Respiratory Technicians and Physiologists (ARTP) standards for the testing should be used wherever possible. For aspects of testing not covered by the ARTP standards, current best practice should be followed.

An outline of the standard measurements include as a minimum, but not limited to:

a. Dynamic lung volume measurement to include: Forced Expiratory Volume in 1 second (FEV 1), Forced Vital Capacity (FVC) and FEV1/FVC ratio ) IAW ARTP standards and using a spirometer that complies with ATS/ERS 2005, has both volume/time and flow/volume curves and a large enough printout to assess the quality of the blow.

b. Dynamic lung volumes using body plethysmography (constant volume box) producing Flow Volume Loop (FVL). This should include subdivisions of the expiratory curve from the FVL, both numerically and with a visual trace. The inspiratory portion of the FVL should also be measured. Other measurements to include FVC, FEV1, Peak Expiratory Flow (PEF) and Forced Expiratory Flow (FEF) (25% 50% 75% and 25-75%) IAW ARTP standards.

c. Diffusing Capacity of the Lungs for Carbon Monoxide (DLCO) IAW ARTP standards.

d. Static lung volumes using body plethysmography including: Total Lung Capacity (TLC), Residual Volume (RV), Functional Residual Capacity (FRC), Vital Capacity (VC). Additionally, a comparison of TLC by plethysmography with the accessible volume from a Gas Transfer (GT) manoeuvre to give an indication of any sequestered intra-thoracic gas not in rapid communication with the exterior through the bronchial tree.

e. FEV1 and PEFR both immediately, and after a period of 10 minutes, following 8 minutes exercise on a static bicycle (maximal effort) breathing dry diving gas.

f. Spirometry post 5 milligram nebulised salbutamol (FEV1 and PEF Rate).

It is anticipated there shall be up to 77 PFT tests per annum to be undertaken within 6 weeks of referral.