Quality statement 1: Diagnosis with spirometry

Quality statement

People aged over 35 years who present with a risk factor and one or more symptoms of chronic obstructive pulmonary disease (COPD) have post‑bronchodilator spirometry. [2011, updated 2016]

Rationale

A diagnosis of COPD is confirmed by post‑bronchodilator spirometry. To ensure early diagnosis, spirometry should be done in primary care when a person presents with a risk factor for COPD (which is usually smoking) and one or more symptoms of COPD.

Quality measures

Structure

a) Evidence of local arrangements and written clinical protocols to ensure that people aged over 35 years presenting with a risk factor and one or more symptoms of COPD have post‑bronchodilator spirometry.

Data source: Local data collection. Royal College of Physicians' National COPD Audit Programme.

b) Evidence of local arrangements and written clinical protocols to ensure that healthcare professionals in primary care using post‑bronchodilator spirometry are trained and competent in its use.

Data source: Local data collection. Royal College of Physicians' National COPD Audit Programme.

c) Evidence of local arrangements to ensure that primary care services providing post‑bronchodilator spirometry are supported by quality control processes.

Data source: Local data collection.

Process

Proportion of people aged over 35 years presenting with a risk factor and one or more symptoms of COPD who have post‑bronchodilator spirometry.

Numerator – the number in the denominator who have post‑bronchodilator spirometry.

Denominator – the number of people aged over 35 years presenting with a risk factor and one or more symptoms of COPD.

Data source: Local data collection. Quality and Outcomes Framework indicator COPD002: The percentage of patients with COPD in whom the diagnosis has been confirmed by post‑bronchodilator spirometry between 3 months before and 12 months after entering on to the register.

Outcome

COPD incidence.

Data source: Local data collection. Royal College of Physicians' National COPD Audit Programme.

What the quality statement means for different audiences

Service providers (primary care services) ensure that quality‑assured post‑bronchodilator spirometry is carried out in people aged 35 years and over who have a risk factor and one or more symptoms of COPD, to confirm diagnosis of COPD. Service providers ensure that healthcare professionals are trained and competent in performing and interpreting post‑bronchodilator spirometry.

Healthcare professionals (in primary care services) ensure that they perform quality‑assured post‑bronchodilator spirometry in people aged 35 years and over who have a risk factor and one or more symptoms of COPD, to confirm diagnosis of COPD. Healthcare professionals ensure they remain up to date with training and competencies in performing and interpreting post‑bronchodilator spirometry.

Commissioners (clinical commissioning groups) ensure that they commission services in which people aged 35 years and over who present with a risk factor and one or more symptoms of COPD receive quality‑assured post‑bronchodilator spirometry to confirm a diagnosis of COPD.

People aged 35 or older who have an increased risk of COPD and who have one or more symptoms of COPD are offered a test to check how well their lungs work (called post‑bronchodilator spirometry). This test is used to diagnose COPD. People are at an increased risk of COPD if they smoke or have smoked in the past, or if they have been exposed to harmful fumes, dust or chemicals, often at work. Symptoms of COPD include breathlessness, long‑lasting cough, coughing up phlegm, frequent winter 'bronchitis' and wheezing.

Source guidance

Chronic obstructive pulmonary disease in over 16s: diagnosis and management (2018, updated 2019) NICE guideline NG115, recommendations 1.1.1, 1.1.5, 1.1.8 and 1.1.10

Definitions of terms used in this quality statement

Risk factors

Risk factors for COPD include:

  • smoking history

  • occupational exposure to harmful fumes, dust or chemicals

  • exposure to fumes, such as biomass fuels.

[NICE's guideline on chronic obstructive pulmonary disease and expert opinion]

Symptoms of COPD

Symptoms of COPD are:

  • exertional breathlessness

  • chronic cough

  • regular sputum production

  • frequent winter 'bronchitis'

  • wheeze.

[NICE's guideline on chronic obstructive pulmonary disease, recommendation 1.1.1]

Post‑bronchodilator spirometry

Post‑bronchodilator spirometry is used to identify abnormalities in lung volumes and air flow. Spirometry should be performed by a healthcare professional who has had appropriate training and who has up‑to‑date skills. The use of post‑bronchodilator spirometry should be supported by quality control processes.

[Adapted from NICE's guideline on chronic obstructive pulmonary disease, recommendations 1.1.9 and 1.1.10]