Spirometry is an essential investigation to diagnose and assess in people with COPD and other respiratory problems. There are significant variations in care and outcomes within the UK and internationally and COPD accounts for:-
- around 115,000 emergency hospital admissions each year.
- 835,000 people in the UK have been diagnosed with COPD
- It is thought that 2.2. million have COPD and have not yet been diagnosed
- 25% of people in a practice who have a diagnosis of COPD may be receiving inappropriate medication and treatment British Lung Foundation (blf.org.uk); NICE
Spirometry – restarting diagnostic testing in primary care
On April 29th, 2021, PCRS, ARTP and BTS updated their guidance. The document offers “practical advice on reinstating spirometry, who should carry it out, when and where it should be performed; it looks at the latest evidence on infection control and provides pointers on how to deal with the backlog of patients.”
Infection control measures
Spirometry is not considered to be an aerosol generating procedure (AGP). However, spirometry-associated cough has the potential to generate aerosol droplets necessitating a mitigation strategy which may include:
- All tests must be performed using a single use antibacterial antiviral filter
- The spirometer must be cleaned between patients per manufacturer’s COVID specific instructions.
- As a minimum this should involve cleaning the outer casing of the transducer and the outer part of the spirometer itself with alcohol wipes.
- Unless the patient is considered high risk for any reason, operators will need Personal Protective Equipment (PPE) consisting of gloves, apron, visor and Type IIR (surgical) mask.
- A Perspex screen between patient and operator offers an additional physical barrier for protection.
- If available, use a room with mechanical air circulation or ventilate as able (e.g. open windows).
- Ideally this should be in the region of 6 room air changes per hour.
- Other options that may be considered depending on the local situation include a drive through service or virtual spirometry.” ( pg.5 )
The document also discusses the pros and cons of this type of diagnostic testing being delivered at a PCN or practice level. The full document can be accessed via this link .
"Improving the Quality of Diagnostic Spirometry in Adults"
In September 2016 a competency framework was published " Improving the Quality of Diagnostic Spirometry in Adults "
The document is quite detailed and we would encourage anyone involved in Spirometry and COPD to have a read. The document is a collaboration between the ARTP and:
- Education for Health
- Association of Respiratory Nurse Specialists
- Asthma UK
- British Lung Foundation
- British Thoracic Society
- Primary Care Respiratory Society UK
The document looked at the establishment of a national register of ‘certified healthcare professionals and operators.’ The objective is to ensure that staff operating, performing and/ or interpreting diagnostic spirometry hold a valid and current certificate of competency. All healthcare professionals had until March 2021 to ensure they have been assessed and are on the register, due to Covid this date has been extended. ARTP FAQs
To be deemed competent to interpret spirometry health care professionals will need to be named on the Association for Respiratory, Technology and Physiology (ARTP) Register. ARTP FAQs ; They will be required to complete the Full Certificate in Spirometry or have completed a Foundation Certificate, topped up with the Interpretation module or gained entry to the register as an experienced practitioner. This is not yet a mandatory requirement but is deemed as best practice. The BMA also has guidance which confirms that currently there are no mandatory training requirements for performing spirometry.
Implementation of the Recommendations
To allow enough time for the necessary training, assessment and certification infrastructure to be set up, it was proposed to phase the implementation of the recommendations over the four-year period from 1 April 2017 – 31 March 2021. Practitioners will eventually need to re-register every three years to maintain their status. The date above due to Covid has been extended. ARTP FAQs .
The Register will have three categories of certification:
- Foundation (Performing Only)
Those who have been assessed as competent to perform safe, accurate and reliable spirometry tests without interpretation This could be a HCA/GPN and or GP who has completed a course in performing spirometry.
- Full (Performing and interpretation)
Those who have been assessed as competent to perform and interpret spirometry in terms of physiological changes. This is likely to be GPNs, a respiratory nurse specialist, physiotherapists (especially respiratory specialist physiotherapists) and GPs who have undertaking a recognised ARTP Full Certificate of Competence in performing and interpreting diagnostic spirometry. Before undertaking the Full Spirometry certificate, practitioners will need to have completed an ARTP Full Spirometry course.
- Interpretation Only
Those who have been assessed as competent in interpretation only (i.e., those with no responsibility/ requirement to perform spirometry but who do have a requirement to interpret accurately the results of spirometry). To be included on the register this individual will need to achieve the ARTP Interpretation Only Certificate of Competence. Some prior knowledge of spirometry interpretation is advisable (refreshers courses are likely to be made available by a variety of organisations). The document states that there is no observed practical assessment at this level. A portfolio of 10 tracings that the individual has interpreted is required, plus a written assignment. This more commonly applies to GPs.
Having your name on the Register
If you have been performing diagnostic spirometry for several years you will not necessarily have to undergo any further training to have your name placed on the register. The Experienced Practitioner Scheme enables experienced individuals to undertake an assessment of competence without attending any specific training. You will need to re-register every 3 years.
The following are useful links that should address any questions you may have around the guidance: Education For Health ; ARTP FAQs ; Spirometry | Primary Care Respiratory Society (pcrs-uk.org)
CQC Views - Last updated: April 2021 - Nigel's Surgery 83: Spirometry in General Practice
This is taken directly from the CQC website April 2021 where information is shared about quality standards and best practice in spirometry and what they expect to see in an inspection. GP mythbuster 83: Spirometry in general practice | Care Quality Commission (cqc.org.uk);
There are several organisations who offer training via; modules, e-Learning, webinars, online and face to face study days. Please refer to their website for costs associated with both training and fees for portfolio assessment and ARTP registration.
- ARTP - Training & Development
- Education for Health - COPD
- Rotherham Respiratory Ltd - Course Protfolio
- BMJ Learning - Spirometry in practice online course
You are also advised to contact: -
- your local training hubs Wessex Primary Care Training Hubs - Working across Wessex (hee.nhs.uk) ; bswtraininghub.nhs.uk – Training Hub
- and the Wessex LMCs training calendar. Wessex LMCs: Education, Training & Development
Other Useful Links
- NICE Overview | Chronic obstructive pulmonary disease in over 16s: diagnosis and management | Guidance | NICE
- BMA https://www.bma.org.uk/advice-and-support/gp-practices/gp-service-provision/spirometry-in-general-practice
- Primary Care Respiratory Society – your essential guide to spirometry Layout 1 (pcrs-uk.org)
- NEW - Update on spirometry guidance | Primary Care Respiratory Society (pcrs-uk.org)
- British Lung Foundation Chronic obstructive pulmonary disease (COPD) statistics | British Lung Foundation (blf.org.uk)