Broad approach to spirometry

Feeling my spirometry skills were not quite up to scratch, I decided to look for a suitable course at reasonable cost. Rather than go to the companies who make the machines, I felt I needed a broader approach and so contacted the National Respiratory Training Centre (NRTC) in Warwick.1

The NRTC was founded in 1987, and since then has trained nearly 30,000 health professionals in various forms of respiratory care in the UK, Europe and the US. Now an accredited institution of the Open University, it offers a number of diplomas, degrees, masters and distance learning, as well as short and one-day courses, which for those with an interest in OH, range from allergy in practice, smoking cessation and asthma, to the one-day spirometry course.

The NRTC has also produced a number of useful publications at reasonable prices, such as the Simply Asthma Pocket Book and Simply Allergy Pocket Book (4.90 each), Simply Stop Smoking Support Packs (19), and a quarterly journal, The Airways Journal.2 You can download previous articles on spirometry from the website.3

The one-day spirometry course cost 85 and was held at the NRTC headquarters, though courses are available elsewhere. The course was attended by 25 people: mainly practice nurses, a few OHNs and several GPs.

The aim of the course was to help gain the practical skills to enable practitioners to get technically-acceptable spirometry results and develop basic understanding of normal and abnormal patterns of spirometry. After attending the course, practitioners should be able to demonstrate basic knowledge and understanding of:



  • The types of spirometer available
  • What is a technically-acceptable result and how to achieve it
  • How to prepare a patient for
    spirometry
  • The common problems encountered in performing spirometry
  • What spirometry measures
  • How to interpret the results
    obtained.

The course began by looking at the various types of spirometry equipment, including the original manual spirometer, which allows people to see exactly what is happening, as well as newer, computerised versions. Deciding which spirometer to use depends on the location, whether you need static or portable, the ease of use, the training available, and, of course, the cost. We learned the importance of the calibration of the machines, and that while this should be carried out daily on the smaller, portable machines, the older, large machines have to be calibrated by the manufacturer and so can only be done annually.

The correct preparation of the patient/client is important to get accurate results. First, obtaining the relevant history – recent, past and family – is essential and this will include obtaining details which may prevent performing spirometry such as:



  • Heart problems
  • Acute infection
  • Tuberculosis
  • Frail people
  • Haemoptysis
  • Pregnancy

If the patient/client is suitable for spirometry, and they are taking medication for respiratory disease, then guidelines were given as to how long these should be withheld before testing. They should not have had a substantial meal for two hours before and should not have undertaken any vigorous exercise for 30 minutes. This may be an issue for OH as appointments may well be made for immediately after lunch, or employees may have hurried – or even cycled – from their workplace to the OH department. They should be wearing comfortable, loose clothing and should be seated for the test.

After the preparation, we learned about the actual test itself, what each part meant and why it was done, how to give encouragement and the importance of doing so, followed by the predicted normal result for age, gender, height and race and results classification. The latter was important for the diagnosis and classification of any respiratory disease.

This was especially useful for me as I had not ever really been aware of the difference, only that there was a problem and to refer to the OH physician. Here, even though I would still refer on, I learned to tell the difference.

The afternoon session was devoted to practical interpretation, for which we had to use a calculator. My natural fear of maths reared its ugly head and it was with some apprehension I returned to the classroom. I needn’t have worried as there was a workbook with exercises, and guidance on what we had to do. Altogether there were 30 questions giving all types of examples of respiratory disease and how to work out the results. The teacher came round to each group and sat with them, answered questions, gave help and support, and the answers.

At the end of the day, there were several useful handouts, course notes and the workbook to take away. My only comment would be that I wish there had been a handout listing references and further reading. However, I now feel much more confident in undertaking spirometry, how to measure and interpret lung function. I only wish that I had known about this course and taken advantage of it before.

References



1. www.nrtc.org.uk
2. Partridge M, (2003) Spirometry: why, where, who and how? The Airways Journal, December 2003. p172-173
3. www.airwaysextra.com


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