Quality standard
Quality statement 1: Diagnosis with spirometry
Quality statement 1: Diagnosis with spirometry
Quality statement
People aged over 35 years who present with a risk factor and 1 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 supported by a quality-control process. 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 1 or more symptoms of COPD (for example, exertional breathlessness, chronic cough, regular mucus production, frequent winter 'bronchitis', and wheezing).
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that healthcare professionals in primary care using post‑bronchodilator spirometry are trained and competent in its use.
Data source: Evidence can be collected from information recorded locally by healthcare professionals and provider organisations, for example from staff training records or staff inclusion on the Association for Respiratory Technology & Physiology Spirometry Register.
Process
Proportion of people aged over 35 years presenting with a risk factor and 1 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 1 or more symptoms of COPD.
Data source: NHS England's Quality and Outcomes Framework includes data on GP practices that have a register of patients with a clinical diagnosis of COPD whose diagnosis has been confirmed by a quality-assured post-bronchodilator spirometry FEV1/FVC ratio.
What the quality statement means for different audiences
Service providers (primary care services) ensure that post‑bronchodilator spirometry supported by a quality-control process is carried out in people aged over 35 years who have a risk factor and 1 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 post‑bronchodilator spirometry that is supported by a quality-control process in people aged over 35 years who have a risk factor and 1 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 ensure that they commission services in which people aged over 35 years who present with a risk factor and 1 or more symptoms of COPD receive post‑bronchodilator spirometry supported by a quality-control process to confirm a diagnosis of COPD.
People aged over 35 who have an increased risk of COPD and who have 1 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 mucus, frequent winter 'bronchitis' and wheezing.
Source guidance
Chronic obstructive pulmonary disease in over 16s: diagnosis and management. NICE guideline NG115 (2018, updated 2019), 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 diagnosing and managing chronic obstructive pulmonary disease in over 16s, recommendation 1.1.1 and expert opinion]
Symptoms of COPD
Symptoms of COPD are:
[NICE's guideline on diagnosing and managing chronic obstructive pulmonary disease in over 16s, 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 diagnosing and managing chronic obstructive pulmonary disease in over 16s, recommendations 1.1.9 and 1.1.10]