Quality assured spirometry
Bridging the gap between evidence and clinical practice
Accurate diagnosis with the use of quality-assured spirometry is critical if there is to be appropriate, cost effective, evidence based interventions.
There are national and international guidelines from specialist respiratory organisations on standards for spirometry which include the equipment, quality assurance, performing the test and interpretation.
Figure 1: National and international spirometry guidelines
Without an accurate, quality-assured diagnosis, patients may be misdiagnosed and therefore inappropriately managed on the wrong treatment pathway. Patients who are being managed inappropriately are more likely to suffer exacerbations, requiring more admissions and readmissions into hospital, which would ultimately lead to poor patient outcomes compared with those patients who have had an accurate, quality-assured diagnosis.
Early findings from the NHS Improvement - Lung projects have found a high proportion of patients who have not received quality-assured spirometry as part of their COPD diagnosis. Patient records in one practice highlighted 15% of patients on the COPD register with no recorded spirometry. This suggests either that the patients have not had the test or the result has not been recorded; either way this probably would result in reduced proactive management of these patients’ disease. In another practice, 44% of patients have been recorded on the COPD register with a FEV1/FVC ratio ≥ 0.7, which suggests that the patient may have been misdiagnosed and therefore does not have COPD; alternatively, there is a possible issue with performance of the technique or interpretation of spirometry results. In a number of practices, there is no clear differentiation between COPD and asthma with one practice recording 69% of COPD patients on both the COPD and Asthma Registers. Differentiation is important if there is to be appropriate clinically effective and cost effective intervention and management for asthma and COPD patients.
Figure 2: Percentage of COPD Patients recorded on both COPD and asthma registers in five practices in Walthamstow PCT
Learning from the projects indicates that there is a great need for earlier, accurate, quality-assured diagnosis along with preventative action to reduce the effects of COPD on the patient and their family, as well as the economic burden of the long term medical management and disability-related costs.
Future work within the NHS Improvement - Lung will focus on the extent of the variation and test ways of bridging the gap between clinical evidence and clinical practice.
More information
For more information about accurate diagnosis, please contact:
Zoe Lord
National Improvement Lead
Lung Improvement Programme
NHS Improvement
Mobile: 0772 176 1744
Email: zoe.lord@improvement.nhs.uk