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Following the publication of the BTS guidelines on chronic obstructive pulmonary disease (COPD), questions were raised concerning the costs of spirometric screening in the detection and management of these patients.1
The guidelines state that a volume/time plot is mandatory for screening2 and that such machines are considerably more expensive than a simple vane spirometer. This led one author to suggest that basic screening should be performed with the latter device and that patients with abnormal results should be sent for full open access spirometric testing at chest clinics for further evaluation.3
Since the publication of the guidelines the Chest Service at St George’s Hospital has received many enquires about an open access spirometry service. We therefore conducted a postal questionnaire of the local GP practices to determine (1) their need for a spirometry service, (2) the level of priority they considered this need should be given, and (3) by whom the service should be provided.
The response rate was 70% (35 practices); 83% considered that there was a need for access to a spirometer following publication of the guidelines but the majority (55%) felt this need was only of medium priority. Most of the practices (83%) thought that a spirometry service should be provided by the Chest Clinic. However, when asked if they would support the allocation of local commissioning resources to establish such a service, only 70% agreed to this.
Clearly our local GPs would prefer a Chest Clinic based open access spirometry service. Whilst this service would be easy to establish, it would place an enormous drain on staff and clinic resources and separate funding would have to be made available.
author’s reply Objective measurement of lung function by spirometry is the single most important recommendation in the COPD guidelines.1-1 However, the guidelines deliberately did not recommend how spirometry services should be set up because this will vary according to local facilities, finance, and politics. The guidelines do recommend a volume-time plot as inspection of the traces is the only practical way of ensuring a degree of quality control on the data, and the extra one-off cost of an appropriate device that should last for years is not a huge burden even for individual practices. The option of open access spirometry services (analogous to the chest x ray service) is already available in some districts and may have financial, and probably quality, benefits—but at the cost of being distant from the patient and the GP. In my own district outreach spirometric testing using hospital technicians to provide locality testing sessions is a compromise between the two that is presently being evaluated.
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