Do all spirometers have to meet the ISO Standard 267823?

Yes, all spirometers placed onto the market since 2009 must conform to the International Standard 26782. The minimum safety requirements specified in this particular International Standard are considered to provide a practical degree of safety in the operation of spirometers. This standard is available for purchase here www.iso.org/standard/43761.html

How can I access the new GLI predicted if my spirometer doesn't contain them?

You can enter your data into the calculator contained on the following website http://gli-calculator.ersnet.org/index.html

I understand that taking antibiotics and/or steroids for a chest infection is a contraindication and you must wait before performing the spirometry test. Please could you clarify the wait time?

Most centres will wait approximately 6 weeks post infective exacerbation before testing, but it may take up to 3 months for the infection to fully resolve and lung function to return to as good as it can be.

Is it the recommendation of the spirometry committee to teach the ARTP/BTS guidelines even if departments do not routinely use these as part of their clinical practice and use the ERS/ATS criteria instead?

Although candidates should be aware of the ERS/ATS reproducibility criteria for spirometry, as we are an ARTP qualification, the ARTP/BTS reproducibility criteria should be used for portfolios and practical examination. The criteria are discussed in the spirometry handbook as well as the 1994 guidelines.

How often should I be performing spirometry to maintain competency?

There is no strict guideline, but it has been suggested that about 25 per year is acceptable (1 every couple of weeks).

Does the ARTP have guidance on SVCs and FVCs?

The SVC and FVC should technically be similar in normal and restrictive disease states. There is no physiological reason for the FVC to be significantly >SVC, this only really occurs due to technical error underestimating the SVC unlike in obstructive patterns, where the FVC may be significantly reduced compared to the SVC due to significant dynamic airway compression during a forced effort.

In line with the most recent ARTP guidelines 2020, reproducibility should be within 150mls for FEV1, FVC and SVC, therefore it would be expected that the SVC and FVC fall within the similar criteria of 150mls. 

Do we need a 3 litre calibration machine to perform spirometry?

The ARTP and the ERS/ATS spirometry guidelines recommends the use of a 3 litre syringe to calibrate and verify spirometers used for quality assured diagnostic spirometry. It is considered a requirement for a high quality spirometry service.

What are the recommended number of air changes for clinical procedure rooms?

When performing respiratory diagnostic investigations, the number of air changes recommended is 10 ACH per hour. This can also be risk categorised by number of air changes:

• >12 low risk
• 6-12 medium risk

Do you need to wear a nose peg during a FVC manoeuvre?

A nose peg for FVC is optional, not mandatory.

Is there any guidance on reproducibility criteria?

Regarding reproducibility criteria, whilst the guidelines from the PCC (2013) QADS (Quality Assured Diagnostic Spirometry in Primary care document) suggest that we should aim for 3 blows to be within 100ml of each other, the ARTP standard for acceptability is that the best 2 of the values obtained from at least 3 good blows should be within 100 mls or 5%.

In line with the most recent ARTP guidelines 2020, reproducibility should be within 150mls for FEV1, FVC and SVC, therefore it would be expected that the SVC and FVC fall within the similar criteria of 150mls. 

Spirometry Protocol

You are required to provide your local spirometry protocol, if you are struggling to meet the expected standard or do not currently have a protocol in place, there is a protocol available for download which can be adopted into your own current practice. Click the button below to download the newly revised Spirometry Standard Operating Procedure 2023.

Download ARTP Spirometry SOP 2023

What references support proper spirometry training in primary care?

Enright PL & Crapo RL. Controversies in the use of spirometry for early recognition in the early diagnosis of chronic obstructive pulmonary disease in cigarette smokers. Clin Chest Med 2000; 21(4): 645-652 K Khatri, R Kaufman, W Baigelman. Utilization of pulmonary function tests by primary care in a community hospital. Am J Med Qual 1994; 9 (2): 49-53. Schermer TR, Jacobs JE, Chavannes NH, et al Validity of spirometric testing in a general practice population of patients with with chromic obstructive pulmonary disease (COPD). Thorax 2003 58: 861-866 Molyneux AWP, Ward MJ, Barber P. General practice based spirometry screening for chronic obstructive pulmonary disease (COPD). Thorax 1998; 53: (Supp4) A85. Bolton CE, Ionescu AA, Edwards PH, Faulkner TA, Edwards SM, Shale DJ. Attaining a correct diagnosis of COPD in general practice (Many GPs need training in the use of spirometers) Respir Med 2005;99:493-500 Akhtar R and Wilson A. A comparison of spirometry in general practice and a pulmonary function laboratory. Primary Care Respiratory Journal Volume 14, Issue 4 , August 2005, Pages 215-220 Articles by Brendan Cooper (Past Chair, ARTP) for GP journals which highlight the need for training in spirometry... Is spirometry in primary care a realistic option? BG Cooper On Air (2001) Issue 4: 3-7. Spirometry: a guide to training, technique and equipment BG Cooper Asthma Journal (2002) Lung Function Services in Primary Care - a lung awaited change? BG Cooper NAPC Review (2004) Spirometry Competences in Primary Care. BG Cooper On Air (2004)

When should you perform a bronchodilator reversibility test?

1. To help diagnose asthma, or observe if a patient with COPD has a reversible element to their disease
2. To check the response to prescribed medications 3. To check the maximum response to the medicine

Who should be performing spirometry?

Only staff who have received relevant, high quality training should be performing spirometry. By 2023, all individuals performing or interpreting spirometry should have undergone the ARTP spirometry certificate and be on the National Register as a qualified practitioner.

How can I access the new GLI predicted if my spirometer does not contain them?

You can enter your data into the calculator contained on the following website http://www.ers-education.org/guidelines/global-lung-function-initiative/tools/excel-individual-calculator.aspx

What are acceptable criteria for a positive bronchodilator response?

This is dependent on the guideline that you use locally, which should be noted in the front of your portfolio. However, any of these will be acceptable: ARTP: an increase in FEV1 > 160ml or in VC > 330ml BTS: an increase in FEV1 > 200ml and >15% change GOLD/ATS-ERS 2005: an increase in FEV1 > 200ml and >12% change. NICE COPD 2010: an increase in FEV1 by >400ml absolute (although in more recent guidance, for example, the SIGN asthma 2016 guidance, this is mostly used to distinguish between asthma and COPD rather than for a positive response).

Can I be added to the ARTP Spirometry Register retrospectively?

Unfortunately attending a course does not mean the you get put on the register. The register is associated with completing the ARTP portfolio and practical exmaination which together give the certificate of competence and therefore entry on the register of competent individuals. Therefore you can only appear on the ARTP register during the period of the validity of the certificate.

Do I really need to be on the Spirometry Register and is it mandatory?

Spirometry must be quality-assured and should only be performed by healthcare professionals that are able to demonstrate ongoing competency. The only nationally and professionally recognised means to demonstrate ongoing competency is ARTP spirometry certification and consequent entry onto the Spirometry National Register, which is an approach supported by the Care Quality Commission.

The Spirometry National Register is the list of practitioners and operators who are certified and demonstrate ongoing competence in the performance and/or clinical reporting of spirometry. The National Register is not currently mandatory but it ensures that all practitioners involved in spirometry have their skills assessed and are certified as competent. The Care Quality Commission (CQC) has indicated that they will check on the quality of spirometry and will take into account whether staff performing spirometry are on the Spirometry National Register when assessing their competence.

Please click here for more information on the Spirometry Register.

What will I have to do to Recertify?

Please go to the Spirometry Recertification page here for more information

Do the evidential spirometries submitted for recertification have to of any particular type?

No, any disease types (including normal) can be submitted.