Spirometry
There are a number of resources available to help you. As this is an area likely to feature strongly in the forthcoming National Strategy, please watch for additional information and guidance that is in preparation at the moment (September 2009).
Guidelines and guidance
British Thoracic Society’s current guidance: Recommendations of the BTS & ARTP. Guidelines for the measurement of respiratory function Resp Med 1994;88:165-194
References for the American Thoracic Society and European Respiratory Society guidance:
Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, et al. General considerations for lung function testing. Eur Respir J. 2005 July 1, 2005;26(1):153-61
Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al.. Standardisation of spirometry. Eur Respir J. 2005 August 1, 2005;26(2):319-38
Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005 November 1, 2005;26(5):948-68
Discussion documents about future uses and standards for spirometry
Primary care
Diagnosis - standards
The GPIAG has just published Diagnostic Spirometry in Primary Care: Proposed standards for general practice compliant with American Thoracic Society and European Respiratory Society recommendations
This document was developed together with the Association for Respiratory Technology & Physiology (ARTP) and Education for Health with comments from the BTS.
Accurate diagnosis is an essential pre-requisite for appropriate management of a condition. Spirometry performed in primary care forms the basis of the diagnosis and differential diagnosis of respiratory and other conditions. This Standards Document provides detailed information for clinicians, managers and healthcare commissioners on the key areas of quality required for delivering reliable diagnostic spirometry in primary care – including training requirements and quality assurance. These proposals and recommendations are designed to raise the standard of spirometry and respiratory diagnosis in primary care and to provide the impetus for debate, improvement and maintenance of quality for diagnostic (rather than screening) spirometry performed in primary care. This document should therefore challenge current performance and should constitute an aspirational guide for delivery of this service.
Case-finding
The same September 2009 issue of the PCRJ also includes a paper by the International Primary Care Respiratory Group Spirometry in primary care case-identification, diagnosis and management of COPD which argues that systematic and opportunistic case-identification efforts in primary care, using questionnaires, careful assessment to identify symptoms, and follow-up spirometry, might improve diagnosis rates and enable earlier detection and management of COPD. It differentiates the use of spirometry for case-identification from its use for diagnosis and its use for monitoring. The paper is cited in a paper published in the Lancet August 2009 by Soriano,Zielinksi and Price doi:10.1016/S0140-6736(09)61290-3 which argues that spirometry is the essential test for diagnosis and monitoring of COPD because it is a reliable, simple, non-invasive, safe, and non-expensive procedure. However, despite substantial effort and investment, implementation of quality spirometry is deficient because of several hurdles and limitations, that are described in the review.
Editorial in Primary Care Respiratory Journal 2009
There is also a linked editorial in the PCRJ related to these papers by Christine Jenkins.
Local Enhanced Service
There is is an example of a Locally Enhanced Service for COPD, set up by Tower Hamlets PCT
including EMIS data collection templates with thanks to the authors: Clinical Effectiveness Group.
Booklet for healthcare professionals
The BTS COPD Consortium was established in 1997 when the BTS COPD Guideline was published. It aimed to provide related educational materials for healthcare professionals; and to raise the profile of this "cinderella disease" amongst health professionals, patients and policy makers. The COPD Consortium continued its work after NICE published its COPD Guideline, developing materials which helped disseminate the key messages in the Guideline, and it met for the last time in June 2007. It has published Spirometry in Practice for download here.
The GPIAG, in conjunction with the International Primary Care Respiratory Group, has published a two-page Opinion Sheet on spirometry that can be downloaded free here. It covers choice of spirometer, how spirometry is performed, reversibility tests, preparation of patients, the procedure, training, and a guide to interpreting spirometry.