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Full spirometry during annual COPD check
Jujubeans

8 Posts

Posted:  16-Feb-2017 12:45
Hello,
I've been out of practice nursing for a little while and have been told we're supposed to do full spirometry during annual COPD checks? Is this right? And if so where is the guidance for this? It seems a bit excessive to be doing this for every single COPD patient?
Thanks
holi

480 Posts

Posted:  17-Feb-2017 06:54
You are supposed to but often I find time constraints mean I do fev1 only. I may bring patients back for a spirometry appointment if they have been unwell especially if I feel they might have problems doing the tests requiring multiple attempts
Inky

376 Posts

Posted:  17-Feb-2017 12:22
I disagree with holi. Presuming you are happy with a diagnosis of COPD, then you do not need to do full Spirometry, by which I assume you mean reversibility? Just the post bronchodilator part of the test.
parker69

136 Posts

Posted:  17-Feb-2017 12:32
Post bronchodilator spiro normal criteria to meet bts guidance not one blow to get an fev1.
CarolC

52 Posts

Posted:  17-Feb-2017 21:43
I do one FVC and one FEV1 -as long as they are similar to last year that is all I do. Symptoms and quality of life far more important. Some patients actually put off coming in because they hate the spirometry part of the review. Significant decrease in FVC I send for CXR. Decrease in FEV1 usually due to ACOS or recent exacerbation
holi

480 Posts

Posted:  18-Feb-2017 06:40
By full spirometry I meant only post bronch. This is what people find confusing as there are actually 3 types of spirometry - baseline, reversibility and post bronch. I'm only stating the new recommendations and in fact mostly do fev1
Nohandmaiden

412 Posts

Posted:  19-Feb-2017 09:08 Log in to like this post
Gold standard is 3 Relaxed blows and three Forced blows. This is because some patients get a greater measurement with RVC than FVC because of air trapping when they do the forced blow,or it makes them cough. If the RVC is significantly greater than the FVC use this to get the ratio. If you only do one blow this could be inaccurate as the test is dependent on maximum effort and the patient won't have done spirometry for a year or more. Also, if you only measure FEV1 and not FVC, you've got nothing to tell you if the patient has restriction and possible lung cancer!! Everyone is becoming too QOF orientated ticking boxes and not looking at what accurate spirometry tells you about a patient. I've found hundreds of patients who are misdiagnosed with COPD due to poor spiromerty techniques and lack of understanding about interpretation.Or done when they have a chest infection or a couple of weeks after. Or not post bronchodilator. Yes look at the whole patient and all their symptoms, but don't downgrade the spirometry part of their annual review. If they can't perform it for any valid reason except them from the spirometry part of QOF.
parker69

136 Posts

Posted:  19-Feb-2017 09:41
Nohandmaiden couldn't have put it better. A single blow to get an fev1 is of no value whatsoever. If the patient can't or doesn't meet bts criteria i.e. 3 relaxed 3 forced blows then exempt. Also keep a hard copy in the records. For future reference.Entering a value to tick a qof box is a waste of time. Spiro is a small but valuable part of the annual copd review.
weezywoo

133 Posts

Posted:  19-Feb-2017 19:47
Completely agree with last 2 posts. Gps are putting increasing pressure on us nurses to just do Qof nursing.
I've refused!
Might bite me on the bum but didn't become a nurse to do bare minimum, or tick boxes. Want to look after my patients well!!!
Nohandmaiden

412 Posts

Posted:  19-Feb-2017 21:07
Me too Weezywoo. I used to be a Nuse Advisor on a Team called COPD Response. We taught Nurses and GPs how to perform spirometry, interpret the results and treat the condition. We would stay in the practice working alongside the PN for 6 wks or until proficient. We also had COPD diplomas and the RERC spiromerty exam. Since the team disbanded in 2004 i've seen a marked decline in interpretation of spirometry and understanding of COPD by PNS. This thread illustrates that perfectly by the comments previous to mine.
neverassume

80 Posts

Posted:  20-Feb-2017 20:24 Log in to like this post
I would absolutely agree with Nohandmaiden. Spirometry must be done properly or not at all- just doing one single relaxed and one forced blow should not be done- this serves no purpose other than ticking a box for QOF.

Neverassume
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