ATS and ERS Update Standards Critical for Exam Preparation

Written by Jeffery M. Haynes, RRT, RPFT, FAARC

The Pulmonary Function Technology Specialty Examination is created and updated by a collaborative committee of technologists and pulmonary physicians to ensure that new CPFT and RPFT credential holders have the required skill and knowledge for current clinical settings. The committee is guided by the body of knowledge and practices set forward by organizations which include the American Thoracic Society (ATS) and the European Respiratory Society (ERS).

The examination committee relies heavily on the current guidelines and standards when creating testing material over pulmonary diagnostic methodology. The ATS and ERS have published updated technical standards about the following activities over recent years:

    • general laboratory and equipment management
    • spirometry
    • diffusion capacity of the lung for carbon monoxide
    • lung volume testing
    • respiratory muscle strength testing
    • bronchial challenge testing
    • field walking testing
    • data reporting and interpretation

Popular textbooks may not always keep pace with the standards set forward by the ATS or ERS. Therefore, candidates who are actively preparing to take the Pulmonary Function Technology Examination are strongly encouraged to refer to the most current ATS/ERS standards for the most up-to-date clinical practices.

To provide ease of access, candidates for the PFT Examination can find a list of current ATS and ERS standards below.


General Laboratory and Equipment Management

American Thoracic Society Pulmonary Function Laboratory Management and Procedure Manual, Third Edition. American Thoracic Society, 2016.

Link to purchase: ATS PF Laboratory Management and Procedure Manual

Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, et al. General considerations for lung function testing. Eur Respir J. 2005 Jul;26(1):153-61.

Link to read: 2005 ATS/ERS General considerations for lung function testing


Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Hall GL, et al. Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement. Am J Respir Crit Care Med. 2019 Oct 15;200(8):e70-e88.

Link to read: 2019 ATS/ERS Spirometry Technical Statement

Diffusion Capacity of the Lung for Carbon Monoxide (DLCO)

Graham BL, Brusasco V, Burgos F, Cooper BG, Jensen R, Kendrick A, et al. 2017 ERS/ATS standards for single-breath carbon monoxide uptake in the lung. Eur Respir J. 2017 Jan 3;49(1):1600016.

Link to read: 2017 ERS/ATS DLCO Technical Standards

Lung Volume Testing

Bhakta NR, McGowan A, Ramsey KA, Borg B, Kivastik J, Knight SL, et al. European Respiratory Society/American Thoracic Society technical statement: standardisation of the measurement of lung volumes, 2023 update. Eur Respir J. 2023 Oct 12;62(4):2201519.

Link to read: 2023 ERS/ATS Lung Volume Technical Statement

Respiratory Muscle Strength Testing

Laveneziana P, Albuquerque A, Aliverti A, Babb T, Barreiro E, Dres M, et al. ERS statement on respiratory muscle testing at rest and during exercise. Eur Respir J. 2019 Jun 13;53(6):1801214.

Link to read: 2019 ERS Statement on Respiratory Muscle Strength Testing

Bronchial Challenge Testing

Coates AL, Wanger J, Cockcroft DW, Culver BH; Bronchoprovocation Testing Task Force: Kai-Håkon Carlsen; Diamant Z, Gauvreau G, Hall GL, Hallstrand TS, Horvath I, de Jongh FHC, Joos G, Kaminsky DA, Laube BL, Leuppi JD, Sterk PJ. ERS technical standard on bronchial challenge testing: general considerations and performance of methacholine challenge tests. Eur Respir J. 2017 May 1;49(5):1601526.

Link to read: 2017 ERS Technical Standard Methacholine Challenge Testing

Hallstrand TS, Leuppi JD, Joos G, Hall GL, Carlsen KH, Kaminsky DA, et al. American Thoracic Society (ATS)/European Respiratory Society (ERS) Bronchoprovocation Testing Task Force. ERS technical standard on bronchial challenge testing: pathophysiology and methodology of indirect airway challenge testing. Eur Respir J. 2018 Nov 15;52(5):1801033.

Link to read: 2018 ERS Indirect Airway Challenge Testing Technical Standards

Field Walk Testing (six-minute walk test)

Holland AE, Spruit MA, Troosters T, Puhan MA, Pepin V, Saey D, et al. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J. 2014 Dec;44(6):1428-46.

Link to read: 2014 ERS/ATS Field Walk Testing Technical Standard

Data Reporting and Interpretation

Culver BH, Graham BL, Coates AL, Wanger J, Berry CE, Clarke PK, et al. Recommendations for a Standardized Pulmonary Function Report. An Official American Thoracic Society Technical Statement. Am J Respir Crit Care Med. 2017 Dec 1;196(11):1463-1472.

Link to read: 2017 ATS PFT Report Standards

Stanojevic S, Kaminsky DA, Miller MR, Thompson B, Aliverti A, Barjaktarevic I, et al. ERS/ATS technical standard on interpretive strategies for routine lung function tests. Eur Respir J. 2022 Jul 13;60(1):2101499. doi: 10.1183/13993003.01499-2021. PMID: 34949706.

Link to read: 2022 ERS/ATS PFT Interpretation Standards