‘It is important to get it right’: Spirometry in primary care

Anastasia Tsirtsakis

8/07/2020 1:09:27 PM

New resources released by the National Asthma Council are designed to guide GPs in performing and interpreting the lung function test.

The new spirometry resources are in line with international standards and current practice.

It is the gold standard test for diagnosing asthma and chronic pulmonary lung disease (COPD).
Yet spirometry continues to be underutilised in primary care settings.
As a result, studies have suggested that COPD is the correct diagnosis for up to 38% of patients aged 40 and above who were originally diagnosed with asthma based only on history and physical examinations.
A 2008 study of 247 Australian GPs found that while three quarters reported having access to a spirometer in their practice, only 12% used it routinely for patients with asthma.
Dr Kerry Hancock, Chair of the RACGP Specific Interests Respiratory Medicine network, has previously told newsGP there are several reasons for this, ranging from time constraints to inadequate Medicare funding to having staff trained to use the device.
‘We know that significant amounts of office-based spirometry is not done properly; there’s an over- or under-diagnosis due to spirometry of somewhere between 20% and 30%,’ she said.
‘So the last thing we want is for nurses and or GPs to be undertaking spirometry that is not done properly and therefore leading to incorrect diagnoses.’
While the COVID-19 pandemic continues, GPs are being urged to use spirometry with caution given concerns regarding infection control in the aerosol-generating procedure.
To give GPs greater confidence in performing and interpreting the important lung function test, the National Asthma Council (NAC) has now released an updated set of spirometry resources that are in line with international standards and current practice.
These include an updated version of the Spirometry handbook for primary care (Spirometry handbook) that is presented in a clear and user-friendly format with practical guidance.
NAC Asthma and Respiratory Educator Marg Gordon led a multidisciplinary team to produce the handbook.
Ms Gordon told newsGP that performing and interpreting spirometry correctly is essential for health practitioners to be able to diagnose and monitor lung conditions.
‘The symptoms, particularly for asthma, are variable and then they can spontaneously resolve, so you can miss the diagnosis,’ she said.
‘Because the symptoms [of COPD] are rather insidious and can just creep up on people, once again they can delay, and delay discussing those symptoms with their doctor.
‘So early spirometry in either of those situations is really helpful in a more accurate diagnosis, which leads to early and correct treatment.’
Since the Spirometry handbook was last reviewed in 2008, new treatments have been introduced for respiratory conditions that have required a change to the guidelines. 
‘Over that time recommendations have changed and there’s been a lot of new medications introduced. So to perform a diagnostic spirometry test you need to withhold bronchodilators before the test and so there’s updated information about [that],’ Ms Gordon said.
‘The resources also include updated information about calibration and infection control, as well as diagrams and tables outlining contraindications of the tests.’
Dr Ian Almond, a GP who assisted in the review process, said spirometry takes out the guesswork and lowers the chance of under-diagnosis and misdiagnosis.
‘Certainly, some people may decide not to use spirometry because they’re a little uncertain and they’re pushed for time,’ he said. ‘So they’ll just go with their instinct and what a patient tells them, which is understandable.
‘But, unfortunately, that is going to miss those people who’ve got conditions which may resemble asthma but aren’t in fact asthma, and require a totally different management, and probably [a] referral.’
Dr Almond said he hopes the resources will give GPs greater confidence to conduct the test and interpret the data.
‘Obviously those figures are only as good as the techniques and equipment used, and the resource fills that gap to ensure that everybody has the chance of getting an accurate reading,’ he said.
‘It is there to guide GPs through it, and certainly they should make the best use of it.’
GPs can also access the free Spirometry quick reference guide, which contains the most salient points of the handbook. A Spirometer buyer’s guide has also been compiled to assist practices that are looking to purchase a spirometer.
In response to the current pandemic, Ms Gordon advised GPs take extra precaution, and refer to the Australian asthma handbook for guidance on coronavirus infection control measures for spirometry.
The coronavirus pandemic has raised concerns for practitioners conducting the test over possible viral transmission, given spirometry has the potential to spread aerosolised droplets into the surrounding air and surfaces.
‘At the moment, the guidelines in terms of performing spirometry with COVID-19 are that they are not done on anyone who’s febrile or anyone who’s got an acute respiratory infective condition,’ she said.
‘Inline filters are [to be] used with the spirometer, and there must be correct infection control procedures in place in terms of disinfection and personal protective equipment (PPE).
‘So it’s not a test that’s being encouraged right now … it’s recommended only in more urgent situations or referring that person to a respiratory laboratory.’
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