Spirometry testing in primary care is not easy: lessons from recruiting the Klang Asthma Cohort in Malaysian primary care

AimSpirometry is an objective test to assess lung function. It is often perceived as a simple test but there are practical challenges for ensuring quality spirometry. There is more than just instructing the patient to perform the test. Successful and accurate result requires satisfactory inspiratory and expiratory techniques and good respiratory effort from the patient. In establishing an asthma cohort in the primary care setting in Selangor, Malaysia, all individuals recruited were required to undergo handheld spirometry. In this abstract, we report practical difficulties when carrying out spirometry testing in a real-life public primary care setting.MethodAll children (aged 5 and above) and adults with physician-diagnosed asthma attending six public primary care clinics were recruited. At recruitment, all were required to perform handheld spirometry by research assistants who had received training. A total of eight attempts were allowed at one sitting to achieve good quality results. ResultsA total of 1280 patients were recruited between 1 July and 31 December 2019. Only 867 (68%) of patients were considered able to perform spirometry satisfactorily, 312 (24%) attempted but failed to produce satisfactory results after eight attempts, and the remaining (8%) were contraindicated for spirometry. Those who failed were due to errors in technique such as hesitation during exhalation, coughing during the test, early cessation during exhalation (< 6 seconds) and incomplete inhalation. Older patients were more likely to perform unsatisfactory technique. These errors have greatly affected the interpretation of spirometry.ConclusionTo achieve good quality spirometry testing is not easy. To improve the quality of spirometry testing, it is essential not only to be trained but experienced to get the best from the variety of patients seen in primary care. Implementation Science/Service Development Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest This research was commissioned by the UK National Institute for Health Research (NIHR) Global Health Research Unit on Respiratory Health (RESPIRE), using UK Aid from the UK Government to support global health research. References and Clinical Trial Registry Information