COPD and Spirometry
There are thought to be approximately 3 million people in UK living with COPD, but only around 1.2 million have been diagnosed. COPD accounts for around 25% of deaths from lung disease and around 115,000 emergency hospital admissions per year.
There is significant variation in care and outcomes both within the UK and internationally (in 2008 premature mortality from COPD was almost twice as high in the UK than the European average). And there is therefore a need to ensure that COPD is diagnosed reliably at the earliest opportunity.
Spirometry is vital to confirming the diagnosis of COPD. The NICE Quality Standard for COPD in adults provides that:
People aged over 35 years who present with a risk factor and one or more symptoms of chronic obstructive pulmonary disease (COPD) have post-bronchodilator spirometry
A new competency framework Improving the Quality of Diagnostic Spirometry in Adults: The National Register of Certified Health Care Professional and Operators (September 2016) has been published in response to an All Party Parliamentary Group inquiry into respiratory deaths, with the aim of driving up standards in diagnostic spirometry. The guidance has been co-produced by ARTP, ARNS, Asthma UK, PCRS-UK, BLF, BTS and Education for Health, and has been endorsed by NHS England. Monica Fletcher, Stakeholder Group Chair and Chief Executive of Education for Health, explains on Respiratory Futures why it’s important to quality assure diagnostic spirometry. Please also see the related documents section of this page for the full document, related guidance and resources.
National COPD Audit Programme
The National COPD Audit Programme has found significant deficiencies in the level of recording of spirometry for patients labelled as COPD: the secondary care and pulmonary rehabilitation audits found that spirometry results were available for only 46% and 62% patients respectively. And in primary care, where spirometry had been performed, one‐ quarter of the values were not consistent with COPD. Recommendations for improvement from those audits include:
- All hospitals should make spirometry results available from every computer
- All admission units and respiratory wards should have basic portable spirometers as part of their standard equipment
- All hospitals should introduce mandatory training for key health professionals to ensure that the measurement and recording of spirometry is understood and undertaken routinely if appropriate
- Latest spirometry (date and value) to be included in hospital discharge information
- Pulmonary rehabilitation programmes should ensure that spirometry results are available at assessment - it is not necessarily a requirement for programmes to conduct spirometry themselves but, if not performed, information should be requested from referrers and recorded.
Please see the full reports from the National COPD Audit Programme for further recommendations on improving care for patients with COPD. A Quality improvement action plan template and other resources collated by the National COPD Audit Programme are available here.