RATIONALE: Spirometry is necessary for the optimal management of patients with respiratory disease. The quality of spirometry performed in the primary care setting has been inconsistent. OBJECTIVES: We aimed to evaluate spirometer accuracy, determine the clinical significance of inaccurate spirometers, and assess the quality of spirograms obtained in primary care offices. METHODS: We tested 17 spirometers used in primary care offices with a waveform generator; accuracy and precision were assessed using American Thoracic Society criteria. The clinical significance of inaccurate instruments was determined by applying the FEV1/FVC error from an obstructed waveform to a clinical data set. Spirogram quality was determined by grading spirograms using acceptability and repeatability criteria. The relationship between the number of tests performed by a clinic and test quality was assessed. MEASUREMENTS AND MAIN RESULTS: Only 1 of 17 spirometers met accuracy criteria, with mean errors for FVC, FEV1, and FEV1/FVC ranging from 1.7 to 3.1%. Applying the percentage error to a clinical data set resulted in 28% of tests being recategorized from obstructed to nonobstructed. Of the spirograms reviewed, 60% were considered acceptable for clinical use. There was no association between the number of tests performed by a clinic and spirometry quality. CONCLUSIONS: Most spirometers tested were not accurate. The magnitude of the errors resulted in significant changes in the categorization of patients with obstruction. Acceptable-quality tests were produced for only 60% of patients. Our results raise concerns regarding the utility of spirometry obtained in primary care offices without greater attention to quality assurance and training.
RATIONALE: Spirometry is necessary for the optimal management of patients with respiratory disease. The quality of spirometry performed in the primary care setting has been inconsistent. OBJECTIVES: We aimed to evaluate spirometer accuracy, determine the clinical significance of inaccurate spirometers, and assess the quality of spirograms obtained in primary care offices. METHODS: We tested 17 spirometers used in primary care offices with a waveform generator; accuracy and precision were assessed using American Thoracic Society criteria. The clinical significance of inaccurate instruments was determined by applying the FEV1/FVC error from an obstructed waveform to a clinical data set. Spirogram quality was determined by grading spirograms using acceptability and repeatability criteria. The relationship between the number of tests performed by a clinic and test quality was assessed. MEASUREMENTS AND MAIN RESULTS: Only 1 of 17 spirometers met accuracy criteria, with mean errors for FVC, FEV1, and FEV1/FVC ranging from 1.7 to 3.1%. Applying the percentage error to a clinical data set resulted in 28% of tests being recategorized from obstructed to nonobstructed. Of the spirograms reviewed, 60% were considered acceptable for clinical use. There was no association between the number of tests performed by a clinic and spirometry quality. CONCLUSIONS: Most spirometers tested were not accurate. The magnitude of the errors resulted in significant changes in the categorization of patients with obstruction. Acceptable-quality tests were produced for only 60% of patients. Our results raise concerns regarding the utility of spirometry obtained in primary care offices without greater attention to quality assurance and training.
Authors: Carlos A Vaz Fragoso; Hilary C Cain; Richard Casaburi; Patty J Lee; Lynne Iannone; Linda S Leo-Summers; Peter H Van Ness Journal: Respir Care Date: 2017-07-11 Impact factor: 2.258
Authors: Brian L Graham; Irene Steenbruggen; Martin R Miller; Igor Z Barjaktarevic; Brendan G Cooper; Graham L Hall; Teal S Hallstrand; David A Kaminsky; Kevin McCarthy; Meredith C McCormack; Cristine E Oropez; Margaret Rosenfeld; Sanja Stanojevic; Maureen P Swanney; Bruce R Thompson Journal: Am J Respir Crit Care Med Date: 2019-10-15 Impact factor: 21.405
Authors: Monica J Fletcher; Ioanna Tsiligianni; Janwillem W H Kocks; Andrew Cave; Chi Chunhua; Jaime Correia de Sousa; Miguel Román-Rodríguez; Mike Thomas; Peter Kardos; Carol Stonham; Ee Ming Khoo; David Leather; Thys van der Molen Journal: NPJ Prim Care Respir Med Date: 2020-06-17 Impact factor: 2.871
Authors: C Kellerer; K Klütsch; K Husemann; S Sorichter; R A Jörres; A Schneider Journal: NPJ Prim Care Respir Med Date: 2020-07-30 Impact factor: 2.871