Introduction
Spirometry is a common lung function test used to diagnose and monitor respiratory conditions. It measures how much air a person can breathe out and how quickly they can do so. The test was first developed by British surgeon John Hutchinson in 1846, who created an instrument to measure lung capacity and introduced the term ‘vital capacity’. Modern spirometers continue to use the same principles to assess lung health.
Guidelines
All spirometry had to be stopped during the COVID pandemic as it is an aerosol-generating procedure (AGP) and the risk of disease transmission was high. Post pandemic, the guidelines were reviewed. NHS England updated their commissioning standards for spirometry in March 2026 following a post-COVID review and the Primary Care Respiratory Society released a statement saying all spirometry should again be delivered by appropriately trained healthcare professionals (PCRS, Nov 2023).
Asthma – The British Thoracic Society gave joint guidelines on asthma (BTS/NICE/SIGN) which were updated in November 2024: Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN) https://www.nice.org.uk/guidance/NG245 These state that asthma should be diagnosed in a person with a clinical history suggesting asthma, with a blood count showing raised eosinophils OR raised exhaled nitrous oxide on a FeNO breath test and, if these tests are not conclusive, to measure bronchodilator reversibility with spirometry.
COPD – Universal guidelines state that a formal diagnosis of COPD cannot be made without spirometry. Updated guidelines were released in September 2023, NICE Chronic obstructive pulmonary disease in adults https://www.nice.org.uk/guidance/qs10/chapter/quality-statement-1-diagnosis-with-spirometry
Other lung conditions diagnosed or monitored with spirometry – including pulmonary fibrosis, bronchiectasis and asbestosis. These are likely to be performed prior referral to secondary care in the early stages and then monitored at specialist hospital clinics.
What does this mean for primary care nurses, NAs and HCAs?
Accurate spirometry is essential for diagnosing respiratory disease and ensuring patients receive appropriate treatment. Training courses provide the knowledge and skills needed to perform and interpret spirometry safely, including equipment calibration, cleaning and quality assurance.
The Association for Respiratory Technology and Physiology (ARTP) sets UK spirometry standards and manages the National Spirometry Register. ARTP certification is the only nationally recognised accreditation for spirometry performance and interpretation and is endorsed by the Primary Care Respiratory Society (PCRS) to support high standards of respiratory diagnosis across the NHS.
The Care Quality Commission (CQC) expects spirometry to be performed and interpreted by competent, appropriately trained professionals and recognises the ARTP Register as evidence of competency. Certification is not mandatory but the CQC actively supports and checks whether staff who perform spirometry are on the ARTP Register, as a way of checking competency (CQC, 2026).
Accreditation
As mentioned, the Association for Respiratory Technology and Physiology (ARTP) sets UK spirometry standards and manages the National Spirometry Register. Approved training providers include Education for Health, Respiratory Matters, NSHI, Rotherham Respiratory and independent ARTP-approved trainers.
The ARTP list the following on their website:
Summary & Resources
Summary
Spirometry is a valuable diagnostic and monitoring tool for respiratory disease. Although there are cost and training considerations, high-quality spirometry improves diagnostic accuracy, supports treatment decisions and can lead to better patient outcomes.
Resources:
Association for Respiratory Technology and Physiology (ARTP) website, see: https://www.artp.org.uk/who/about_artp.aspx
Association for Respiratory Technology and Physiology (ARTP) Spirometry Standards Document (July 2024) https://spirometry.artp.org.uk/_userfiles/pages/files/artp_spirometry_standards_v62.pdf
Asthma + Lung UK: COPD in the UK: Delayed diagnosis and unequal care Executive summary and recommendations (Nov 2022) https://www.asthmaandlung.org.uk/conditions/copd-chronic-obstructive-pulmonary-disease
British Journal of General Practice (BJGP) Spirometry services in England post-pandemic and the potential role of AI support software: a qualitative study of challenges and opportunities (2023) https://bjgp.org/content/73/737/e915
British Medical Journal (BMJ) “Silent scandal” of missing lung diagnostics in England’s most deprived areas—where respiratory disease is most prevalent (Sept 2023) https://www.bmj.com/content/382/bmj.p2140
BTS/NICE/SIGN Joint Guideline on Asthma: diagnosis, monitoring and chronic asthma management (Nov 2024) https://www.brit-thoracic.org.uk/clinical-resources/guidelines/asthma-chronic/
Care Quality Commission (CQC) GP mythbuster 83: Spirometry in general practice (2026) https://www.cqc.org.uk/guidance-providers/gps/gp-mythbusters/gp-mythbuster-83-spirometry-general-practice
Medical International Research (MIR) (2026) https://spirometry.com/en/news/using-a-spirometer-in-respiratory-rehabilitation-tips-and-best-practices/
NICE Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN) (Nov 2024) https://www.nice.org.uk/guidance/NG245
NICE Chronic obstructive pulmonary disease in adults (Sept 2023) https://www.nice.org.uk/guidance/qs10/chapter/quality-statement-1-diagnosis-with-spirometry
NHS England: Commissioning standards for spirometry (March 2026) https://www.england.nhs.uk/long-read/commissioning-standards-for-spirometry/
Primary Care Respiratory Society: PCRS Position Statement – Spirometry in primary care (Nov 2023) https://www.pcrs-uk.org/resource/current/pcrs-position-statement-spirometry-primary-care
Primary Care Respiratory Society (PCRS) National Register for Spirometry (2026) https://www.pcrs-uk.org/national-register-spirometry