Quality of routine spirometry tests  in Dutch general practices.
BACKGROUND
Spirometry is an indispensable tool for diagnosis and monitoring of chronic airways disease in primary care.


OBJECTIVE
To establish the quality of routine spirometry tests in general practice, and explore associations between test quality and patient characteristics.


METHODS
Analysis of routine spirometry test records.


METHODS
Fifteen general practices which had a working agreement with a local hospital pulmonary function laboratory for spirometry assessment regarding test quality and interpretation.


METHODS
Spirometry tests were judged by a pulmonary function technician and a chest physician. Proportions of test adequacy were analysed using markers for manoeuvre acceptability and test reproducibility derived from the 1994 American Thoracic Society spirometry guideline. Associations between quality markers and age, sex, and severity of obstruction were examined using logistic regression.


RESULTS
Practices performed a mean of four (standard deviation = 2) spirometry tests per week; 1271 tests from 1091 adult patients were analysed; 96.4% (95% confidence interval [CI] = 95.6 to 97.2) of all tests consisted of ≥3 blows. With 60.6% of tests, forced expiratory time was the marker with the lowest acceptability rate. An overall 38.8% (95% CI = 36.0 to 41.6) of the tests met the acceptability as well as reproducibility criteria. Age, sex, and severity of obstruction were associated with test quality markers.


CONCLUSIONS
The quality of routine spirometry tests was better than in previous reports from primary care research settings, but there is still substantial room for improvement. Sufficient duration of forced expiratory time is the quality marker with the highest rate of inadequacy. Primary care professionals should be aware of patient characteristics that may diminish the quality of their spirometry tests. Further research is needed to establish to what extent spirometry tests that are inadequate, according to stringent international expert criteria, result in incorrect clinical interpretations in general practice.
Schermer
Tjard R J
TR
Department of Primary and Community Care, Asthma and COPD Research Unit, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. t.schermer@elg.umcn.nl
Crockett
Alan J
AJ
Poels
Patrick J P
PJ
van Dijke
Jacob J
JJ
Akkermans
Reinier P
RP
Vlek
Hans F
HF
Pieters
Willem R
WR
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D058006:General Practice; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017060:Patient Satisfaction; D011787:Quality of Health Care; D013147:Spirometry / Q000592:standards*