Chronic Obstructive Pulmonary disease (COPD) is a clinical diagnosis that should be based on carefully history taking, the presence of symptoms and assessment of airway obstruction (also called airflow limitation). The GOLD international COPD guidelines1, as well as national guidelines2, advise spirometry as the gold standard for accurate and repeatable measurement of lung function. Evidence is emerging that when spirometry confirms a COPD diagnosis, doctors initiate more appropriate treatment. Spirometry is also helpful in making a diagnosis in patients with breathlessness and other respiratory symptoms and for screening in occupational environments.
Although the use of spirometers in primary care is increasing, in some countries uptake is still low. In those countries where spirometry is in more common usage, there are major concerns regarding the technical ability of operators to perform the test and interpret its results. Many primary care physicians , nurses, and other health care providers have had little formal training in spirometry. More accredited courses are appearing but these are often time consuming and fairly expensive. Many clinicians feel apprehensive about purchasing a spirometer because of uncertainties about performing and interpreting spirometry. Epidemiologic studies confirm that both late diagnosis and under-diagnosis of COPD are common—problems that wider use of spirometry could help to address.