Spirometry and Lung Function Tests

Overview

Spirometry for diagnostic or monitoring purposes is becoming more widely available in primary care. Access to spirometry in general practice is still patchy but is part of the supplementary services basket so should be more widely available over the course of 2024/25. 

There are useful instructions on how to perform spirometry and on interpretation of results on the patient.co.uk website.

The NBT Respiratory Physiology webpage has some useful information and patient information leaflets.

Lung Function Tests other than spirometry

Referrals for lung function testing other than spirometry cannot be requested directly. Patients should be referred to appropriate respiratory clinics via eRS initially for assessment of lung function requirements.

Spirometry in Children

This page is for adults (age 16 years or over) only. Please see Asthma in Children - Chronic page for advice in children (under 16).

Referral criteria

Referral to secondary care for consideration of spirometry or FeNO testing

Where possible, spirometry or FeNO testing should be undertaken in primary care. If access to spirometry or FeNO testing is not available then clinical assessment and other objective testing should be used if appropriate (1,2). If COPD is suspected or if there is diagnostic uncertainty then appropriate reasons for referral into secondary care services would be:

• A GP practice or its PCN doesn’t have a spirometer or a trained practitioner available to do testing.
• A patient has already been tested at the GP practice but has poor technique which they feel a more experienced practitioner would be able to coach the patient through to be able to achieve a set of results.
• Support with interpretation of results (consider using Respiratory Advice & Guidance Service) 

If a referral is made then the GP must state if they want a bronchodilator given and the dose and delivery device (The standard dose is 4 x 100mcg salbutamol as single puffs via spacer(3)). Patients should also be given information about spirometry Spirometry - NHS

• (1) Diagnosis | Asthma | CKS | NICE
• (2) Diagnosis - COPD | CKS | NICE
• (3) Spirometry_e-guide_2013.pdf

Referral - UHBW

This service is NOT for routine monitoring of patients with stable respiratory disease.

Please also note referral criteria above.

Patients who require spirometry testing will be seen by appointment only via eRS referral (Respiratory NOS).  Please complete the referral template, ensuring you clearly state which of these test options you require: 

• Spirometry 
• Spirometry + Salbutamol MDI 400mcg + FeNO 
• Spirometry + Salbutamol nebuliser 2.5mg + FeNO 

The clinic is unable to give Salbutamol unless this is clearly requested. The results will be uploaded to Clinical Document Service (CDS) for the requesting GP to review the results.  If you require the results to be sent back by a different means, then please indicate this on the referral.

Contact details:  

• Telephone: Lung function appointments 0117 342 1890

Referrals - NBT

This service is NOT for routine monitoring of patients with stable respiratory disease.

Please also note referral criteria above.

Patients who require spirometry testing will be seen by appointment via ICE referral ONLY (Location on ICE is under GP Other Diagnostics). 

This service is for patients 16 years old and above.

Tests offered are -

• Spirometry 
• Spirometry + Salbutamol nebuliser 2.5mg
• Fractional Exhaled Nitric Oxide (FENo)

Salbutamol will not be administered unless this is clearly requested. 

Contact details: 

• Telephone - Respiratory Physiology appointments 0117 4145400 for further information.
• Email -  respiratoryphys.bookings@nbt.nhs.uk

Resources

Effects of COVID-19 pandemic on Spirometry 

The COVID-19 pandemic severely disrupted the provision for diagnostic spirometry in primary care.

Some patients with respiratory symptoms who may have been given a provisional diagnosis during the pandemic, are still awaiting diagnostic spirometry to confirm their diagnosis. There was a rise in newly prescribed inhaled bronchodilators during the pandemic, which raises concerns that some provisional diagnoses will have resulted in patients being prescribed medications they may not need while waiting for spirometry testing and results (PCRS, 2021).

NHSE/I have advised that spirometry should be undertaken to limit patient harm. The following documents have were agreed by a local task & finish group comprising of the CCG, LMC and two practice nurses to support the restarting of spirometry in the community:

• Risk minimisation in spirometry re-start
• Spirometry patient information
• Spirometry protocol (Standard Operating Procedure) for primary care

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.