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The British Thoracic Society is to be congratulated on the new COPD guidelines1 which are clear and will prove a major boon to patients and their carers in primary care.
Spirometry lies at the heart of these guidelines, perhaps most importantly in screening for asymptomatic cases amongst smokers. After all, there is no cure. In our practice we perform such screening on smokers over 40 years old. To be effective, screening must be largely opportunistic. We own both a simple vane spirometer costing around £300 which states only FEV1 and FVC values, and a more accurate device costing £1400. This produces a full range of results, interpretation, and quality checks. The guidelines state that a volume/time plot is mandatory, thus condemning cheaper varieties.
Both of these devices have their place. The cheap one is ideal for screening by general practitioners and respiratory nurses; it is quick and simple to use. The recommended expensive variety is wholly unsuitable for this purpose as it takes at least 10 minutes to set up and calibrate let alone print out the result. We use it only to check those with abnormal results on screening, as well as in “asthma/COPD” clinics where it is set up and used repeatedly.
It is unrealistic to expect most practices to purchase two types of spirometer and our experience would suggest that the cheap spirometers are preferable for routine primary care use with abnormal results being checked by an open access spirometry service. Furthermore, such a service is no substitute for performing spirometric measurements in house. If cheap vane spirometers are condemned, opportunities for preventing this devastating disorder will be lost.
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