Improving spirometry testing by understanding patient preferences

The American Thoracic Society and European Respiratory Society commissioned a task force to update the technical standards for spirometry testing with the aim of increasing the accuracy, precision and quality of spirometry measurements and improving the patient experience. To inform the task force with patient experiences, the European Lung Foundation, in collaboration with the task force, conducted an online survey in 10 languages between August and September 2018. There were 1760 respondents from 52 countries. The majority were adults (97.1%); the most common reasons for spirometry referral were diagnosis (35.0%) and management of an ongoing condition (60.1%). 53.2% reported regularly using inhalers. Respondents were very experienced with spirometry: 89.9% completed more than one test; 48% completed 10 or more tests. However, most reported not knowing what forced expiratory volume in 1 s (FEV₁) means (59.4%) and only 39.6% knew their most recent FEV₁; the exception was respondents with cystic fibrosis who reported much greater knowledge. Respondents rated as moderately or seriously problematic: being told to keep blowing when they felt nothing is coming out (31.4%), coughing (30.4%), tiredness (26.3%) and concern about shortness of breath (20.1%). Overall, respondents found spirometry to be acceptable; however, an important minority (17%) found it difficult. Patients want clear information before, during and after the test, including information on stopping medications. Operators have an important role in increasing the ease of patients and changes to the testing environment can increase patient comfort. Patients want access to their results and want to understand how they relate to their individual health.