Quality Spirometry in Primary Care

The Role of the Respiratory Clinical Physiologist

Spirometry in Primary Care

Advantages

• Closer to the patient

• Ideal position to detect early stages – Screening those with risk factors

• Development COPD slow – symptoms noted when lung function is 50-60%

• COPD mainly managed in primary care

Spirometry in Primary Care

Concerns

• Interpretation

• Little formal training- technical ability/ only performed occasionally

• Quality control

• Choice of Spirometer

• Courses time consuming/ expensive

• Other competing demands

The Ideal• ARTP Foundation Certificate in Spirometry

o perform spirometry without interpreting the results

• ARTP Full Certificate in Spirometryo perform and interpret spirometry

• ARTP Accredited Spirometry register

• ARTP Spirometry Re-Accreditationo Every 3 years

Implementationo Number of people that need qualification

• 1-2 people performing spirometry in each practice

o Cost of qualification• Foundation – cost of 1 day training course plus £150

for exam/ certificate• Full – cost of 2 day training course plus £200 for

exam/ certificate

o Time for qualification

o Limited training centres

Spirometry Tips• The Spirometer

o To guide practices on what spirometer they should purchase

• The Operatoro The operator should be trained and competent in performing the test

• Quality Controlo When spirometer calibration should be verified, calibrated syringe,

biological control

• Predicted Valueso Which to use, height measured accurately

• Acceptabilityo How many VC and FVC manoeuvreso Acceptability criteriao How to recognise artefacts/ poor efforts/ common errors

Acceptability

Common Problems• Non-Maximal Effort Cough

•

Future Options• All practitioners performing spirometry to attend

accredited training course/ certification

• ‘Spirometry Practitioners’ to be identified that cover a number of practices – full training/ certification

• Over reading and interpretation of results by Respiratory Clinical Physiologists

• Respiratory Clinical Physiologists to perform spirometry in community

• Practices provide ‘evidence of competence’ that is assessed by physiologists