Practice Of Spirometry Research Articles

Spirometry practice by French general practitioners between 2010 and 2018 in adults aged 40 to 75 years

In France, most spirometries are performed by pneumologists. Spirometry is difficult to access due to the distance to medical office and long delays for appointments. This lack of accessibility contributes to the underdiagnosis of chronic obstructive pulmonary disease (COPD) among patients aged between 40 and 75 years. In recent years, general practitioners (GPs) have been performing spirometry in private practice. However, the extent of this practice is unknown. A French retrospective, repetitive transversal study analysed data from the “Système National des Données de Santé” (SNDS) database. The targeted population was GPs in primary care that performed spirometries between 2010 and 2018, in patients aged between 40 and 75 years. Between 2010 and 2018, 302,674 (7.2%) spirometries were performed in France by GPs in private practices, in patients 40 to 75 years old. 5.4% by “expert GPs” (>60 spirometries/year) and 1.8% by “non-expert GPs”. In “non-expert GPs” (2.8% of French GPs in 2018), the annual number of spirometries increased by 701 each year (p < 2.104), the annual number of GPs performing spirometries increased by 114 each year (p < 2.10−5). Overall, 24.9% of the spirometries performed by GPs were referrals from other GPs. The number of spirometries performed by GPs and the number of GPs performing spirometries has gradually increased over time. However, this increase is inadequate considering the need to early detect and follow up respiratory disorders.

Spirometry practice and the impact of a phase 1 training workshop among health workers in southern Nigeria: a cross-sectional study

BackgroundGlobal standards require that spirometry should be performed by trained and experienced personnel, who would be able to assess the correct performance of tests by patients and assure good quality of the result. The complete achievement of this requires a two-step assessment where competency in both knowledge and skills are tested. This study aims to assess the impact of a one-day hands-on spirometry training (Phase1), on the knowledge and application of spirometry among health workers.MethodsThis was a descriptive cross-sectional study, which describes a one-day (seven hours) spirometry training and skills impartation done at two conference city locations in Enugu and Calabar in the southern part of Nigeria. All the verbally consenting attendees who completed the training assessment tests constituted the study population. The assessment of the spirometry knowledge base before and after the theory and practical sessions, on the various aspects of spirometry, according to international best practices, quality assurance and the interpretation of results, was done and the outcome was analyzed. Factors that could affect the outcome were also assessed.ResultsThere were 64 consenting participants of whom 54.7% (35/64) were females. Theparticipants demonstrated much improved post-intervention knowledge and could satisfactorily perform spirometry, calibration, interpretation of test results and quality control as evidenced by the post test scores after practical sessions were conducted. Pre-test mean scores improved by a mean difference of 12% (p < 001) and were affected by the year of academic graduation and availability of spirometers at the place of work, an effect that was no longer seen at post-test following the hands-on spirometry training.ConclusionThe present study has shown that a one-day spirometry workshop significantly improved the knowledge of spirometry practice. There is need to set up more frequent locally-organized spirometry workshops since a one-day seven-hour effective knowledge and practical training would most likely have significant impact on participants’ spirometry practice with its expected positive outcome on respiratory health in Nigeria.

Use of office spirometers in Flemish general practice: results of a telephone survey

While office spirometry is seen as potentially useful and feasible in general practice, little is known about its use in Flemish general practice. Our aim was to describe the use of spirometers by Flemish GPs, characteristics of their spirometry practice, training needs and preferences, and attitudes towards office spirometry. A telephone survey was set up in a random sample of Flemish GPs. Interviews were carried out by a GP researcher using a structured piloted questionnaire. 197 out of 243 eligible GPs (81%) were interviewed. Most GPs (66%) had never used an office spirometer, 17.3% were using one and 16.7% stopped using one. Time constraints (54%) and insufficient knowledge and skills (27%) were the main reasons for not using an office spirometer (any longer). GPs particularly used their spirometer to diagnose COPD and asthma, and less frequently in follow-up. GPs (67.9%), especially current users (91.2%), considered spirometry as a GP task. Spirometry training should be provided (86%) and spirometry by GPs should be reimbursed (79.5%). More information on spirometry would be very useful (62.3%), with a marked preference for training in small groups (86.8%). Although office spirometry is not widespread in Flemish general practice, GPs show an undoubted interest in it. They need educational and financial support to overcome prevailing barriers in establishing office spirometry on a routine basis.

A Comprehensive, National Survey of Spirometry in Spain

We aimed to evaluate the availability and practice of spirometry, training of technicians, and spirometer features and maintenance in Spain in both primary care (PC) and secondary care (SC) centers. We used a nationwide, cross-sectional, 36-item telephone survey of health-care centers in Spain to target the technician in charge of conducting spirometries in PC and SC centers where outpatient respiratory patients are routinely evaluated. The questions surveyed for resources, training, spirometer use, bronchodilator tests, and spirometer features and maintenance. Of a total of 1,259 centers screened, 605 PC centers (21.2% of the PC centers in Spain) and 200 SC centers (24.9% of the SC centers in Spain) were surveyed. The response rate was 85.4% for PC centers and 75.1% for SC centers. All together, 19% of screened centers did not have a spirometer or were not using it. The number of spirometers per center and spirometries conducted per week was higher in SC centers than in PC centers (P &lt; .001). Most centers received training for conducting spirometries, but this was periodically done in &lt; 40%. Most centers used two inhalations of salbutamol for the bronchodilator test, but the international criteria of a positive test was considered only in 55.8% of PC and 52.8% of SC centers. Calibration of the spirometer was never done in 10.5% of PC and 3.1% of SC centers. This survey maps for the first time, to our knowledge, the current situation of spirometry in Spain, identifying bottlenecks and suggesting future directions applicable in both PC and SC centers and elsewhere.

How to pass your European Spirometry Driving test!

The information in this editorial is designed to inform Breathe readers about the European Spirometry training programme leading to the ERS Spirometry Driving Licence. The vital role of spirometry in the diagnosis and management of respiratory disease is undisputed [1, 2]. Standardisation of spirometry, access to spirometers and use of accurate and reliable spirometry measurements are requirements central to the treatment of lung diseases [3, 4]. Are you aware that: European Respiratory Society (ERS) have recognised the need to standardise spirometry practice with the publication of the ERS/American Thoracic Society (ATS) guidelines, Standardisation of Lung Function Testing 2005 [4]. In recent years, a number of new spirometers have been introduced to the market, some of which have been independently validated and the ERS Buyers' Guide also offers guidance to those performing spirometry in practice. However, to date, there has been relatively little achieved in the standardisation of training and education in spirometry measurement across Europe. Although efforts have been made in a number of European countries to train health professionals at a national and local level, results of an ERS survey 2012 highlight that content and duration of training vary widely and few training programmes are recognised by a professional body [8]. What do we learn from this? Although a number of quality spirometers are now available with guidelines available on lung function testing, no …

HERMES Spirometry: the European Spirometry Driving Licence

Spirometry testing is the most widely practiced, most common and adaptable of all lung function tests and spirometers are used as a key instrument in the diagnosis of patients with respiratory disease [1]. As a leading cause of death worldwide responsible for some 9.4 million deaths [2], and further increases predicted by 2020, the management of lung disease becomes even more dependent on spirometry testing. Yet evidence of widespread under-diagnosis [3] and, as a consequence, reduced quality of life and premature death [4] present cause for concern. The grim reality evident in the presented studies highlights a real lack of training [5], under-utilisation of spirometers [6] and diagnosis based on inaccurate results [7]. It is reported that chronic obstructive pulmonary disease (COPD), the most prevalent of the lung diseases, is under-diagnosed in 75% of cases [3]. The outcome of delayed diagnosis deters effective management and treatment, which ultimately aims to relieve symptoms, prevent disease progression, improve health status and prevent premature death [4]. While educational modalities were introduced at a national level to train spirometry practice in some European countries, a survey carried out by the European Respiratory Society (ERS) in 2008 confirms that no formal training in, assessment of, or qualification in spirometry takes place in many other countries. Using the HERMES project framework (Harmonised Education of Respiratory Medicine in European Specialties), a new Spirometry initiative aspires to train and qualify healthcare professionals best able to deliver high-quality spirometry. The potential benefits of standardised educational documents and training in the practice of spirometry are real and significant, strengthening patient care and improving quality of life for respiratory disease patients. Begun in 2005, the value of the HERMES initiative is that it …

Harmonising spirometry education with HERMES: training a new generation of qualified spirometry practitioners across Europe: Figure 1–

“Hundreds of millions of people of all ages suffer from preventable chronic respiratory diseases and respiratory allergies in all countries of the world… accounting for 4 million deaths annually” 1. The considerable toll of respiratory diseases in terms of quality of life, disability of patients and indeed premature death 2 underlines the importance of spirometry in the detection and monitoring during the management of respiratory disease. Yet, in the past two decades, there have been specific concerns of under-utilisation in screening 3, lack of training 4 and misdiagnosis based on inaccurate results 5, 6 which only serve to document the inadequacies in spirometry practice not only within Europe but on a world-wide scale. An abundance of reports 2–8 has propelled quality issues in the practice of spirometry to centre stage and consequently introduced a number of quality improvement strategies. High-quality spirometry relies on three key determinants: 1) documented guidelines in spirometry, 2) access to quality spirometers, and finally, 3) trained and qualified spirometry practitioners 9. To some degree, the ERS/ATS guidelines in standardisation of spirometry 10 and availability of affordable spirometers across medical settings have directly addressed these first two factors. Further efforts implemented in the US by NIOSH (National Institute for Occupational Safety and Health), in several European countries, as well as across New Zealand and Australia through ANZSRS (Australian and New Zealand Society of Respiratory Science) have produced comprehensive training structures with supporting documents and certification criteria to endorse health professionals with a qualification to practice high-quality spirometry. There is some evidence which consistently shows that competence in spirometry is the key to quality services 7, 11, 12, but access to such training and assessment is relatively limited. Adopting HERMES (Harmonising Education in Respiratory Medicine for European Specialists) as …

Evaluation of Current Knowledge, Awareness and Practice of Spirometry among Hospital -based Nigerian Doctors

BackgroundSpirometry is a cost-effective diagnostic tool for evaluation of lung function and for case-finding in a resource-limited setting. The acceptance of this test depends on the awareness of its indications and the ability to interpret the results. No studies have assessed the knowledge of spirometry among Nigerian doctors. The aim of this study was to evaluate the current knowledge, awareness and practice of spirometry among hospital-based Nigerian doctors.MethodsWe carried out a cross-sectional survey among 321 doctors working in Nigerian hospitals between March 2008 and June 2008. Information on knowledge, awareness, practice of and barriers to spirometry were obtained using a pre-tested, self-administered structured questionnaire and the data were then analysed.ResultsOf the 321 doctors that participated, 108 (33.6%) reported that they have good knowledge of spirometry. One hundred and ninety-five (60.7%) were aware of the importance of spirometry in aiding the diagnosis of respiratory diseases; 213(66.4%) were aware of the importance of spirometry in determining the severity of diseases. Medical school was the most common source of knowledge on spirometry (64.5%). Eighty-one (25.2%) doctors reported having a spirometer in their hospitals. Doctors having access to a spirometer used it more frequently for aiding the diagnosis of COPD (40.7% vs.27.5%) and for monitoring of asthma (18.5% vs.11.3%) than those without access to a spirometer. The doctors working in University Teaching Hospitals and Federal Medical Centres (FMC) (22.4% vs. 4.5%) and those having access to a spirometer (40.7 vs.11.3%) were very confident of interpreting spirometry results compared to those working in District and General Hospitals and without access to a spirometer. Irrespective of access to a spirometer or the type of hospital they were employed in, doctors reported that unavailability of a spirometer was the greatest barrier to its use (62.5%) followed by lack of awareness about its usefulness (17.2%).ConclusionThe knowledge and practice of spirometry were poor among hospital-based Nigerian doctors because of unavailability of spirometers in most hospitals. These findings have implications for further evaluation, planning and management of patient care in respiratory disease. Spirometers should be made available in all hospitals, and the knowledge of spirometry should be improved among doctors.

Knowledge and practice of spirometry among pediatricians in Riyadh, Kingdom of Saudi Arabia.

BACKGROUND:Spirometry is the most basic, widely used and effort-dependent pulmonary function test. It assesses the lung volumes and flows, and is ideally suited to describe the effects of restriction or obstruction on lung function. Therefore, keeping in view the clinical applications of spirometry, this study attempts to explore the knowledge and practice about spirometry among pediatricians.MATERIALS AND METHODS:A questionnaire-based study was conducted across multiple centers in various hospitals in Riyadh, Saudi Arabia. The structured questionnaire, based upon knowledge and practice of spirometry, was distributed to 150 pediatricians in the various tertiary care hospitals in the metropolitan area of Riyadh.RESULTS:Ninety-four percent of 113 pediatricians agreed that spirometry is a valuable tool in pediatric clinical practice. However, knowledge relating to spirometry was lacking among pediatricians, and about 86% of the study population did not demonstrate up-to-date knowledge of spirometry in pediatrics. Only 11% of pediatricians were very confident in interpreting spirometry results. No statistically significant association was observed between the distribution of responses relating to knowledge and practice of spirometry and the study variables including academic position, duration of practicing experience and number of patients attended daily.CONCLUSION:The results indicated that pediatricians in Riyadh were lacking adequate knowledge about the clinical applications of spirometry in their daily clinical practice. Hence, it was suggested that pediatricians should attend periodical training, workshops and continuous medical education programmes to enhance their knowledge. This should especially be performed during their pediatric residency training programmes, as spirometry is one of the essential components in clinical practice.

Benefits of a modified spirometry technique

To the Editors: We applaud the American Thoracic Society (ATS) and the European Respiratory Society for their continuing efforts to optimise pulmonary function testing practice through disseminating guidelines, such as the recent spirometry guidelines 1. In reviewing this document, we wish to point out a spirometry practice that, although mentioned (but not endorsed) in the guidelines, can, in our experience, substantially improve and streamline the performance of spirometry by pulmonary function laboratories 2. Specifically, we point out the benefits of a modified spirometry technique in which the expiratory effort is relaxed after the first 3 s of expiration. As evaluated and reported in a small, randomised, controlled, crossover trial of two expiratory techniques and …