How High-Quality Spirometry Can Improve Respiratory Diagnosis in Primary Care

By Charlene Mhangami, Lead UK comPAS™ Clinical Specialist, Vitalograph

High-quality spirometry gives you objective evidence to support earlier respiratory diagnosis, guide referral decisions and monitor lung function over time. This article looks at where spirometry adds the most value in primary care, what reliable testing requires, and how to build it into your everyday diagnostic pathway.

Key Takeaways

Reliable spirometry results depend on trained operators, the right device for the purpose, and testing to the ATS/ERS 2019 standard.
Spirometry and FeNO provide complementary information - combining them, where available, reduces repeat appointments and delay.
Wider access to quality-assured spirometry in primary care can support earlier diagnosis and reduce avoidable delay in treatment.

Why spirometry is needed in primary care

Primary care is often the first point of contact for people with respiratory symptoms. Objective tests such as spirometry and fractional exhaled nitric oxide (FeNO) — interpreted alongside clinical history and treatment response — can improve your diagnostic confidence. They also help you decide whether a condition can be managed in primary care or needs onward referral, reducing repeat appointments and delays to diagnosis.

Symptoms alone cannot provide all the information needed for a respiratory diagnosis. Spirometry measures the volume and flow of air exhaled after a full inhalation. It can identify airflow obstruction or findings that may suggest a restrictive ventilatory defect.

Access to high-quality spirometry in primary care can be limited by funding, staff training, service design and patient-related factors.

As respiratory disease diagnoses rise, and mortality attributed to respiratory disease remains high, improving access to objective testing matters more than ever. Primary care providers are well placed to support early detection, diagnosis and long-term management of respiratory disease — helping to reduce mortality over time.

Spirometry overview

Spirometry commonly reports vital capacity (VC), forced expiratory volume in one second (FEV1), the FEV1/FVC ratio and peak expiratory flow (PEF). The clinical indication will determine which parameters are required for interpretation.

Results are compared with reference values based on variables such as age, height and sex. Percentage-predicted values are used in some diagnostic criteria, while z-scores and lower limits of normal provide a more statistically appropriate way to identify results outside the expected range. Absolute values are also useful for tracking lung function over time, provided test quality and testing conditions are comparable.

Important considerations for testing

Reliable spirometry depends on obtaining technically acceptable and repeatable measurements. Competent operators and appropriate quality assurance are also key. The ATS/ERS 2019 technical statement provides the international benchmark for test performance. Reliable testing requires:

• Suitable initial training, plus regular practice and refresher education to maintain competence

• A device matched to the purpose of testing — handheld monitors may support case-finding or screening, while diagnostic spirometers must provide the accuracy, quality-control features and measurements needed for full assessment

• Preparation and maintenance that follow the specific device's instructions and your local quality-assurance procedures, since these vary by technology and manufacturer

Modern spirometers are available in handheld and PC-based formats, making testing easier to deliver in primary care. It's worth understanding the measurement technology behind each device, as this affects preparation, maintenance and quality assurance. Low-cost respiratory monitors typically use turbine-based technology, which is useful for screening, but not suitable for diagnostic spirometry. Diagnostic spirometers, by contrast, may use technologies such as Fleisch or ultrasonic flow measurement, designed for full assessment and greater precision.

Respiratory monitors and screeners do not require calibration verification; diagnostic spirometers do, according to the ATS/ERS 2019 technical statement. Modern diagnostic spirometers are generally highly stable and seldom, if ever, need recalibration. However, calibration verification is important to confirm that the device is operating correctly and has not been damaged since it was last used. The rationale for testing should always determine the device used and the preparation required.

Note: Patient safety is central to spirometry. Before testing, the operator should explain the effort required, check for relative contraindications in line with ATS/ERS guidance and consider whether forced respiratory manoeuvres could place the patient at unnecessary risk. If a contraindication is present, or if its clinical significance is uncertain, testing should be deferred until an appropriate clinical opinion has been obtained.

Applying spirometry in primary care pathways

Disease-specific guidance helps you decide when to use spirometry for diagnosis, monitoring and ongoing management. Relevant sources include GOLD guidance for COPD; the joint BTS, NICE and SIGN guidance for asthma; GINA guidance for asthma; and NICE guidance for idiopathic pulmonary fibrosis.

In an asthma pathway, FeNO and spirometry provide complementary information: FeNO assesses type 2 airway inflammation, while spirometry evaluates expiratory airflow and may demonstrate variable airflow obstruction. Where both tests are indicated and locally available, coordinating them within the diagnostic pathway can reduce repeat visits and avoid unnecessary delay. Bronchodilator responsiveness should be assessed using the criteria in the current applicable guideline, rather than in isolation from the wider clinical picture.

FeNO testing: FeNO measures type 2 airway inflammation. A raised result may support an asthma diagnosis when it is consistent with the patient's symptoms and clinical history. A normal or low result does not exclude asthma, particularly non-type 2 asthma.
Baseline spirometry: Spirometry measures expiratory airflow and may identify abnormalities in lung mechanics such as airflow obstruction. Results should meet recognized quality standards and be interpreted alongside symptoms, clinical history and other objective findings.
Bronchodilator responsiveness: Baseline spirometry is performed first. A bronchodilator, commonly salbutamol, is then administered and spirometry is repeated after the appropriate interval. The change in FEV1 should be assessed using the criteria in the relevant diagnostic guideline and interpreted within the wider clinical picture.
Coordinated testing: Where FeNO and spirometry are both indicated and available, completing them within the same diagnostic pathway can reduce repeat appointments and unnecessary delay. The pathway should also define when abnormal, unclear or technically unacceptable results require repeat testing, further investigation or referral.

Note: FeNO and spirometry provide complementary information rather than interchangeable results. FeNO assesses type 2 airway inflammation, while spirometry assesses lung function and variable obstruction.

Optimizing spirometry in primary care

Preventing exacerbations through monitoring

People with respiratory conditions may experience exacerbations that affect their health and quality of life. Regular clinical review — including symptom assessment and appropriately timed objective testing — can help you identify deterioration and guide management. Full spirometry or selected measurements may support monitoring over time, but results should be considered alongside symptoms, treatment use and exacerbation history. Where software supports trending, comparable high-quality results can help you identify meaningful changes in lung function.

Reducing diagnostic delays

Limited access to objective testing can lengthen the diagnostic pathway and leave patients receiving treatment without a confirmed diagnosis. Wider access to diagnostic spirometry — supported by trained staff and clear referral pathways — can improve diagnostic confidence and help patients receive appropriate treatment sooner. Screening or case-finding tools can identify people who may need full diagnostic assessment, but they are not substitutes for diagnostic-quality spirometry.

Supporting prevention and early identification

Although not all respiratory disease is preventable, earlier identification can support risk reduction, timely diagnosis and better disease management. You can use symptoms, smoking history and occupational or environmental exposures to identify people who may benefit from objective assessment. A brief screening test may support case-finding in selected groups, but abnormal or unclear results require appropriate diagnostic follow-up.

Using respiratory monitoring within screening pathways

Respiratory monitors can support case-finding pathways by providing selected measurements such as FEV1, PEF or FEV6. Results outside the expected range may lead to further clinical assessment and, where appropriate, diagnostic-quality spirometry. These devices can help you assess patients efficiently, but results must be considered alongside other patient information and the wider diagnostic pathway. They should not be used alone to confirm or exclude a diagnosis of respiratory disease.

Conclusion

Training requirements, funding pressures and service-implementation challenges remain real barriers. But advances in spirometry technology, and the availability of cost-effective devices, are making respiratory assessment more accessible in primary care. Understanding device capabilities, ensuring operator competence and maintaining a strong focus on patient safety are fundamental to getting results you can rely on in clinical decision-making.

Spirometry is one of the most valuable objective tools available for respiratory diagnosis and management in primary care. Performed and interpreted to recognized standards, it can identify airflow obstruction, provide evidence of a possible restrictive pattern, and track changes in lung function over time.

WHAT THIS MEANS FOR YOUR PRACTICE

Invest in operator training and refresher education, not just initial certification.
Match your device to its purpose. Respiratory monitoring and screening tools are useful but are not a substitute for diagnostic-quality spirometry.
Build FeNO and spirometry into a single coordinated pathway where both are available.
Define clear criteria for when abnormal, or technically unacceptable results trigger repeat testing or referral.

By integrating spirometry with clinical assessment and complementary tests such as FeNO, primary care teams can improve early diagnostic confidence, reduce avoidable delays and support more timely, patient-centred care. As a long-standing provider of respiratory diagnostic solutions, Vitalograph is committed to helping primary care teams build exactly this kind of reliable, standards-aligned testing capability, from device selection through to operator training.

Discover V-Core Flowhead Technology for Spirometry

Clinical recommendations and criteria cited in this article are based on the current guidance and technical standards listed in the references below.

References

Graham, B.L., Steenbruggen, I., Miller, M.R., Barjaktarevic, I.Z., Cooper, B.G., Hall, G.L., Hallstrand, T.S., Kaminsky, D.A., McCarthy, K., McCormack, M.C., Oropez, C.E., Rosenfeld, M., Stanojevic, S., Swanney, M.P. and Thompson, B.R. (2019). Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement. American Journal of Respiratory and Critical Care Medicine, 200(8), pp.e70-e88. doi:10.1164/rccm.201908-1590st.
National Institute for Health and Care Excellence (2024). Overview | Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN) | Guidance | NICE. Available at: https://www.nice.org.uk/guidance/NG245 [Accessed 21 Aug. 2026].
Asthma + Lung UK (2026). Transforming respiratory diagnostics: the way forward. Available at: https://www.asthmaandlung.org.uk/transforming-respiratory-diagnostics-way-forward [Accessed 5 Aug. 2026].
Stone, P.W., Osen, M., Ellis, A., Coaker, R. and Quint, J.K. (2023). Prevalence of Chronic Obstructive Pulmonary Disease in England from 2000 to 2019. International Journal of Chronic Obstructive Pulmonary Disease, 18, pp.1565–1574. doi:10.2147/copd.s411739.
Derom, E., van Weel, C., Liistro, G., Buffels, J., Schermer, T., Lammers, E., Wouters, E. and Decramer, M. (2008). Primary care spirometry. European Respiratory Journal, 31(1), pp.197–203. doi:10.1183/09031936.00066607.