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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