Recent guidelines and protocols for the diagnosis of asthma and COPD mean that most GP practices possess a spirometer in one form or another.
BTS guidelines for COPD subdivide individuals by severity and tailor their management plan accordingly. Hence the spirometer is not just a tool for diagnosis but also for lifetime disease monitoring.
The latest Vitalograph was summarised at the European Respiratory Society Congress as 'simple yet sophisticated'. The size of a tablet PC, it is lightweight (3.96kg) and portable from desktop to desktop, helped by a built-in carry handle. It has no moving parts and uses a LCD touch screen (stylus provided) with easy-to-follow instructions.
There are just four options on the main menu. These are 'new subject', 'recall subject', 'perform test' and 'print report'.
Our respiratory nurse found it easy to set up a 'new subject' or patient, do a test and print the result. It was simply a case of following the instructions to set up patient demographic data or full details on smoking history, COPD diagnosis and asthma.
In addition, the print-outs were sharp and easy to read.
Recalling previous patients by name or ID was easy and the system has a fail-safe in that the same subject cannot be entered more than once.
The respiratory nurse was confused by the pre-set parameters because she was used to a different format. However, we were able to choose more familiar settings and so rejected information that was irrelevant to us such as FVC and FEV1.
This model can store up to 1,000 individual subject data and 70 years of readings for each individual patient.
Disappointingly, the spirometer wouldn't integrate with our patient software, so it was a case of printing each person's reading and scanning them into the system. The alternative option is to keep the data in the Vitalograph Compact which does come with the option of backing up the collected data on to CD via a USB terminal.
Vitalograph is so confident in the robust and reliable nature of its product that, as long as you have an annual service and calibration carried out by the company, parts are guaranteed for five years.
This model breaks from another tradition too. Rather than just giving per cent predictive values based on age, height and sex it also gives the option of using standard deviation scores. In the future, this might be more accurate than the current standard, which is apparently based on poor science.
You can also set up the Vitalograph for more serious spirometry testing by using a bacterial/viral filter instead of the disposable mouthpieces for expiratory testing. This allows you to do both inspiratory and expiratory testing to give you flow/volume loop; with that, the machine can be set up to have 40 pre-defined parameters of respiratory function.
It claims a +/- accuracy of 3 per cent, which meets all standards and uses a 10V DC power supply. This is included, so there are no batteries to change.
I was impressed by the step-up technology and the time this saved in setting up the record and producing the results.