Spirometry Resources

Diagnostic spirometry is key to supporting a clinical diagnosis of lung impairment. As a result of Covid-19, spirometry services in primary care were all but cancelled. There was much debate about the potential risks associated with spirometry as a potential aerosol generated procedure (AGP); clarity was needed for patients and staff. The evidence is now clearer, spirometry is not an AGP, although spirometry-associated cough has the potential to release airborne particles in the air, associated with an increased risk of transmission of harmful viruses such as Covid, influenza and the common cold. This article explores recent evidence to support the safe re-introduction of quality-assured spirometry in primary care, looking at how risks can be mitigated to try to readdress the backlog of diagnostic spirometry thought to be in the region of 200–250 patents per 500,00 population. Spirometry is important to reduce health inequalities for patients yet to have a diagnosis of lung disease.

Idiopathic pulmonary fibrosis (IPF) is a relatively rare chronic, progressive lung disease with a poor prognosis. General practice nurses (GPNs) have a pivotal role in supporting patients and their families at all stages of the disease trajectory. This article aims to raise the profile of this terminal lung condition and provide nurses with an introductory understanding of the disease, the diagnostic pathway, and treatment options available for patients. As core members of the multidisciplinary team, GPNs are well-placed to provide access to other healthcare professionals and services who together can improve the lives of patients living with this condition.

Celebrating 30 years of improving lives

Welcome to this issue of GPN. We are delighted to share the latest news in the world of Education for Health, especially at the start of this very special year — we are celebrating our 30th anniversary!

This is an important milestone in our charity’s history and one we are looking forward to celebrating in 2017. During the year we will thank those who have contributed to our success, reflect on our achievements and make ambitious plans for the future. We plan to mark our anniversary with a number of activities in May and June.

The 21st September 2016 saw the launch of the latest version of our national asthma guideline, published jointly by the British Thoracic Society and the Scottish Intercollegiate Guidelines Network (BTS/SIGN, 2016).

The original BTS guideline was published in 1990, and SIGN’s own version dated back to 1996. In 1999 the two organisations recognised the need to develop a joint guideline, the result of which was the 2003 BTS/SIGN asthma guideline (SIGN/BTS, 2011).

This is the seventh version of this guideline, which has been produced in conjunction with a range of stakeholders including the Royal College of Physicians (RCP), Primary Care Respiratory Society (PCRS), Asthma UK and Health Improvement Scotland (HIS).

Here, Chris Loveridge reflects on a patient story where the focus slipped away from the patient resulting in a failure of care.

As nurses, one of the first things we are taught is how to communicate with patients. It is also important to look out for clues that might help to assess their condition. For example, in patients with breathlessness this could mean:

• Observing how they walk towards us, the degree of breathlessness
• Looking at their skin colour when they reach us — both at their hands as they greet us and their lips when they are talking
• Reaching across to reassure and feel the texture of their skin and perhaps even the radial pulse. Once taught, these skills are never forgotten and, added to a conversation, can encourage patients to relate how they feel, and thus, begin the process of history-taking.

There is widespread recognition that respiratory disease has been under prioritised and neglected for many years (All-Party Parliamentary Group [APPG], 2014). Those of us who work in primary care feel this is improving, although we recognise we still have a long way to go. We have welcomed guidance and guidelines that promote good respiratory care, as the patient, not the diagnosis, is key to what we do. 

Spirometry is very easy to do, and very easy to get wrong (Martin, 2010; personal communication). Not only is quality
assured spirometry dependent on the effort exerted by the patient, and the technical ability of the spirometer operator,
but also on the understanding of the results by the person interpreting them.

Interpretation of the results is essential if any meaningful decision is to be made about the patient’s care.