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NIOSH Safety and Health Topic:

Spirometry Training Course

What is the NIOSH-approved spirometry training course?

The Cotton Dust Standard [29 CFR 1910.1043 (
show_ document?p_table=STANDARDS&p_id=10053&p_text_version=FALSE)
], promulgated by the Occupational Safety and Health Administration (OSHA) gives the National Institute for Occupational Safety and Health (NIOSH) the responsibility to approve courses in spirometry for instruction of those individuals who will be administering screening pulmonary function testing to employees who are exposed to cotton dust. In addition, Appendix D of the Cotton Dust Standard (
specified minimal requirements for valid spirometry testing in the occupational setting of the cotton processing industry. These spirometry training and testing criteria have been widely accepted for testing workers in occupational settings beyond the cotton industry.

NIOSH approves a spirometry training course when it determines that the course meets the minimum OSHA/NIOSH criteria for the instruction of individuals who perform spirometry in the cotton textile industry. Course approval does not mean that an individual taking the course is certified as a pulmonary function technician. Upon successful completion of a NIOSH-approved course, students are provided with a course certificate by the course director.

The Cotton Dust Standard does not require any prerequisite or supplemental courses be taken in order to successfully complete a course approved by NIOSH. Currently, there is no requirement for continuing education or refresher courses after completion of a NIOSH-approved spirometry course, though occupational and respiratory professional organizations recommend periodic refreshers. NIOSH is considering whether to recommend periodic retraining at some point in the future. If and when NIOSH determines that re-training is appropriate, the new recommendations will be posted on this website.

Spirometry Training Course

Spirometry Flow Volume Curve Chart

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What is the purpose of the course certificate?

Students who successfully complete a NIOSH-approved spirometry training course will receive a certificate from the course director. Most course directors issue the certificate on the final day of the course. The certificate is awarded to the student for successfully completing the class and is not transferable to any organization, company, or institution that may have provided financial assistance or reimbursement for the student’s expenses.

The certificate should, at a minimum, contain the sponsor’s name, the student’s name, dates and location of the course, the NIOSH course approval number, and the signature of the approved director responsible for that course. Certificates may also indicate the awarding of continuing education credit if this has been granted by specific accrediting organizations.

The certificate may be requested as part of an OSHA inspection of a cotton-related industrial site and should therefore be retained by the student. To obtain duplicate copies of course certificates, individuals should send a written request to the sponsor of their course. NIOSH does not maintain copies of individual course certificates.

Licensure of health professionals is generally the function of a state board, and issuance of a course certificate does not imply that NIOSH has certified that student as a pulmonary function technician, nor does it imply that NIOSH warrants the performance of the student after completion of the course.

What is the design and content of an approved course?

The course design must include at least 16 hours of instruction with the following components:

  1. At least four hours of formal lectures and/or audio visual material.
  2. At least eight hours of small group practical instruction.
  3. At least two hours per student devoted to evaluation and testing of the student's spirometry testing skills. Evaluation consists of a written and a practical examination.

The course content should include:

  1. Basic physiology of the forced vital capacity maneuver and the determinants of airflow limitation with emphasis on the relation to reproducibility of results.
  2. Instrumentation requirements including calibration procedures and sources of error and their correction.
  3. Performance of testing including subject coaching, recognition of improperly performed maneuvers, and corrective actions.
  4. Data quality with emphasis on reproducibility.
  5. Actual use of the equipment under supervised conditions.
  6. Measurement of tracings and calculation of results.

Information may be presented during a course that is not required by the Cotton Dust Standard. However, this must be in addition to the minimum 16 hours of instruction required by the Standard. Though all NIOSH-approved courses must have the minimal required content in common, the courses vary somewhat in the additional topics that are covered, and some courses are more than 16 hours in length.

How can I find an existing NIOSH-approved course?

NIOSH maintains a list of active course sponsors, which is posted on this web site. A calendar of courses is also maintained for your convenience. However, course schedules are very dynamic, and the calendar may not be entirely up-to-date. Be sure to verify the location and timing of courses with the sponsor. Some course sponsors offer the option for students to register for a class on the sponsor’s website. Some sponsors also will travel to a requestor’s site to give a course. Contact the individual sponsor to make these arrangements.

Course sponsors are located throughout the United States and in Mexico. A few sponsors teach courses regionally, nationally, and internationally. If you do not find a sponsor close to your home, search the calendar of courses to find the nearest one to you.

Sponsor Location Map Albuquerque, NM Salt Lake City, UT Half Moon Bay, CA Bremerton, WA Tacoma, WA Seattle, WA Houston, TX location Birmingham, AL Dallas, GA Tampa, FL W. Columbia, SC Greensboro, NC Morrisville, NC Lexington, KY Cincinnati, OH Iowa City, IA Rochester, MN Minneapolis, MN Elkhorn, WI Indianapolis, IN Univ Illinois - Chicago, IL Pittsburgh, PA Carleton, MI Virginia Beach, VA Norfolk, VA Chesapeak OH Services - Baltimore, MD John Hopkins Univ - Baltimore, MD New Brunswick, NJ Concord, MA Amesbury, MA Tlalpan, Mexico

List of NIOSH-Approved Course Sponsors

Schedule of NIOSH-Approved Courses

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How can I contact NIOSH regarding a course already taken?

Comments, questions, or suggestions regarding the NIOSH-Approved Spirometry Training Program may be directed to the NIOSH program coordinator. To contact the program coordinator, you can write, phone, fax, or e-mail:

NIOSH-Approved Spirometry Training Program
Division of Respiratory Disease Studies
Mail Stop H-G900.2
1095 Willowdale Road
Morgantown, West Virginia 26505-2888
304-285-5792 (voice)
304-285-6111 (fax)

How does one become a NIOSH-approved spirometry course faculty member?

Course sponsors must request approval from NIOSH of faculty before they can teach in any NIOSH-approved course. Course sponsors must submit their faculty request to NIOSH. Individuals who wish to teach a NIOSH-approved spirometry course should either contact an approved sponsor or submit an application for course sponsorship. Faculty designations are not transferable between course sponsors. In other words, faculty who are approved for one sponsor may not teach for another sponsor until the second sponsor submits a separate request and receives approval from NIOSH.

There are established minimum requirements for course faculty. Criteria for determining a faculty member’s participation level are as follows:

A. Course Technical Director

The course technical director must meet one of the following criteria:

  1. a physician who has at least 3 years training and experience in the technical procedures and instrumentation for spirometry testing and in the diagnosis of occupational lung diseases or 1 year full-time experience supervising a pulmonary function laboratory,
  2. a health professional with an advanced degree in pulmonary physiology or a related field who has at least three years training and experience in the technical procedures and instrumentation for spirometry testing (e.g., Ph.D. in pulmonary physiology, bioengineering, etc.), or
  3. a health professional with licensure or professional certification in the pulmonary function testing field with at least three years documented experience under the supervision of individuals strictly described in 1. or 2. above.

It is the responsibility of the course director to assure that all faculty meet qualification criteria and that the course content is consistent with the minimum requirements established in the OSHA Cotton Dust Standard. The course director should be an active participant in the course through supervision of all faculty, monitoring the progress of each student, and availability to answer questions which arise in lecture or practice sessions.

B. Course Lecturer

Each course lecturer must meet one the following criteria:

  1. a faculty-level member of the institution (MD or PhD) with at least 1 year of teaching experience at the collegiate level or equivalent (basic anatomy and physiology or some course related to spirometry),
  2. an instructor-level member of the institution (RN, RRT, MS) with greater than 50% of workload dedicated to teaching or with at least 3 years teaching experience,
  3. a health professional with licensure or professional certification in the pulmonary function testing field with at least three years documented teaching experience under the supervision of individuals described in 1. or 2. above.

The course lecturer is responsible for teaching the course content as defined by the requirements in the OSHA Cotton Dust Standard. The lecturer must have intimate knowledge of spirometry testing guidelines and techniques. The greatest strength of the lecturer is to present the information by whatever method necessary so that each student can understand the material and apply it to the practice of collecting spirometry data.

C. Practicum Instructor

The practicum instructor shall have at least three years experience in background, training, and the practical aspects of collecting spirometry data (e.g., occupational health nurses or pulmonary function technicians). This instructor should also have successfully completed a NIOSH-approved spirometry course.

The practicum instructors are responsible for the small break-out groups whereby students gain hands-on-knowledge in correctly administering spirometry tests, including coaching subjects and operating a spirometer. Students will also practice identifying spirometry curves with errors and gain knowledge in how to prevent the error in subsequent trials.

How does one get approved to be a course sponsor?

Within NIOSH, the responsibility of approving courses has been delegated to the Division of Respiratory Disease Studies and is carried out by a Course Approval Committee. Course approval is granted to a sponsor upon satisfactory review of a complete application. Sponsors may be NIOSH Education and Research Centers (ERC), academic institutions, non-profit organizations, or private companies. Potential sponsors must submit 3 copies of an application which will be reviewed for faculty qualifications, facility and equipment capabilities, course design and content, and examination instruments.

Minimum requirements for approval of a course are contained in Appendix D of the OSHA Standard (
and include criteria for apparatus, technique, interpretation, course content, and hours of instruction. NIOSH has established additional criteria for faculty qualifications and course format.

Applications for sponsorship approval should be submitted to:

NIOSH-Approved Spirometry Training Program
Division of Respiratory Disease Studies
Mail Stop H-G900.2
1095 Willowdale Road
Morgantown, West Virginia 26505-2888
304-285-5792 (voice)
304-285-6111 (fax)

Is there a training manual available for these courses?

NIOSH provides a training manual which course directors may use in whole or part. Each course director is responsible for distributing materials relevant to his or her course. A copy of the NIOSH Spirometry Training Manual can be accessed by clicking on the following link [DHHS (NIOSH) Publication No. 2004-154c] or by contacting the CDC-INFO public information contact center:, 1-800-CDC-INFO (1-800-232-4636), TTY: 1-888-232-6348. A Spanish translation of this training is available:

The training guide contains several examples of calculating predictive values for FVC, FEV1, and FEV1/FVC. A Reference Calculator is provided for your use as you work through the sample problems in the training manual and is not intended for use in clinical interpretation. Look-up tables for NHANES IIII predicted values are also provided for practicum use when students compare their own measured values to reference values.

Links to essential components of a quality spirometry program

The American Thoracic Society (ATS) is an independent, non-profit educational and scientific organization with a goal to reduce morbidity and mortality from respiratory disorders and life-threatening acute illnesses. The ATS is a world leader in the fight against respiratory diseases and provides statements, guidelines, and reports which contain state-of-the art information for the diagnosis and treatment of respiratory diseases. ATS has published several statements and guidelines ( which relate to spirometry testing and are available on the ATS website under the “Pulmonary Function and Exercise Testing” category.

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Page last updated: June 3, 2008
Page last reviewed: June 3, 2008
Content Source: National Institute for Occupational Safety and Health (NIOSH)