Quality Assurance of Spirometry for COPD Clinic
Accreditation in Thailand
Chaicharn Pothirat MD, FCCP*,
Warawut Chaiwong BS*, Nittaya Phetsuk BS*
Affiliation :
* Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine,
Chiang Mai University, Chiang Mai, Thailand
Objective : To evaluate quality of spirometry for COPD clinic accreditation.
Material and Method: A minimum of 25 spirograms from each of 38 hospitals were evaluated using the American Thoracic
Society (ATS)/European Respiratory Society (ERS) acceptability criteria. Technicians were separated into two groups based
on their respective level in spirometry training, previously trained-certified, and naïve (not formally trained-certified) groups.
Unpaired t-test and Chi-square were used to compare differences between the two groups. Statistical significance was set
at p<0.05.
Results : Thirty-eight technicians from 38 clinics submitted a total of 1,556 spirograms for accreditation evaluation.
Of those, 1,066 (68.5%) spirograms met all ATS/ERS acceptability criteria. Only 47.4% of the clinics received an A grade.
All clinics that received an A grade were staffed by trained-certified technicians. Significantly, more spirograms failed to
meet the criteria from clinics with naïve technicians than clinics with trained-certified technicians (18.2% vs. 80.8%, p-value
<0.001). Criteria where the trained-certified group significantly achieved than naive group were satisfactory exhalation
(93.4% vs. 20.9%, p-value <0.001), no early termination (98.5% vs. 58.6%, p-value <0.001), maximal effort throughout
(96.2% vs. 89.1%, p-value <0.001), and good start (91.6% vs. 79.9%, p-value <0.001).
Conclusion : Spirometry performed by the Thoracic Society of Thailand trained-certified technician was distinguishably
higher quality than by a naïve technician. Our results are a reminder of the importance of quality assurance for spirometry
in clinical practice.
Keywords : Spirometry, Chronic obstructive pulmonary disease, Train, Technician
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