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 perform spirometry without interpreting the results ARTP Full Certificate in Spirometry perform and interpret spirometry ARTP Accredited Spirometry register ARTP Spirometry Re-Accreditation Every 3 years

Implementation Number of people that need qualification 1-2 people performing spirometry in each practice 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 Time for qualification Limited training centres

Spirometry Tips The Spirometer The Operator Quality Control To guide practices on what spirometer they should purchase The Operator The operator should be trained and competent in performing the test Quality Control When spirometer calibration should be verified, calibrated syringe, biological control Predicted Values Which to use, height measured accurately Acceptability How many VC and FVC manoeuvres Acceptability criteria 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