What are the key indications for performing spirometry in primary care settings?

Key indications for performing spirometry in primary care settings include:

• Suspected diagnosis of chronic obstructive pulmonary disease (COPD) in individuals over 35 years with risk factors such as smoking history presenting with symptoms like exertional breathlessness, chronic cough, regular sputum production, frequent winter bronchitis, or wheeze. Spirometry supports diagnosis and is essential at initial assessment, to reconsider diagnosis if treatment response is atypical, and to monitor disease progression ¹.
• Assessment of respiratory function in patients with incidental findings suggestive of emphysema or chronic airways disease on chest X-ray or CT scans, even if asymptomatic, to guide further management and risk stratification ¹.
• Evaluation of respiratory symptoms that may indicate other chronic respiratory conditions, including differentiating COPD from asthma, especially when clinical features overlap or diagnosis is uncertain ¹.
• Baseline and ongoing respiratory function assessment in conditions like motor neurone disease (MND) to monitor respiratory muscle involvement, using spirometry measures such as forced vital capacity (FVC) or vital capacity (VC) as part of multidisciplinary care ².
• Investigation of unexplained breathlessness or respiratory symptoms in primary care to identify obstructive or restrictive lung disease, as spirometry is a fundamental clinical measurement for assessing lung function and guiding diagnosis and management (Pierce, 2005).

Additional considerations: Spirometry should be performed by trained healthcare professionals with quality control processes in place ¹. Post-bronchodilator spirometry is recommended to confirm COPD diagnosis ¹. Routine reversibility testing is generally not necessary for initial diagnosis or treatment planning in COPD, as it may be misleading ¹.