The reliability and utility of spirometry performed on people with asthma in community pharmacies

Abstract

Objective: To investigate the reliability and the utility of spirometry generated by community pharmacists participating in two large asthma intervention trials of 892 people. Methods: The Pharmacy Asthma Care Program (PACP) and the Pharmacy Asthma Management Service (PAMS) involved up to four visits to the pharmacy over 6 months for counseling and goal setting. Pharmacists performed spirometry according to ATS/ERS guidelines to inform management. The proportion of A–E, F quality tests, as per EasyOne™ QC grades, were recorded. Lung function results between visits and for participants referred/not referred to their general practitioner on the basis of spirometry were compared. Results: Complete data from 2593 spirometry sessions were recorded, 68.5% of spirometry sessions achieved three acceptable tests with between-test repeatability of 150 ml or less (A or B quality), 96% of spirometry sessions included at least one test that met ATS/ERS acceptability criteria. About 39.1% of participants had FEV₁/FVC values below the lower limit of normal (LNN), indicating a respiratory obstruction. As a result of the service, there was a significant increase in FEV₁ and FEV₁/FVC and asthma control. Lung function values were significantly poorer for participants referred to their general practitioner, compared with those not referred, on the basis of spirometry. Conclusions: Community pharmacists are able to reliably achieve spirometry results meeting ATS/ERS guidelines in people with asthma. Significant improvements in airway obstruction were demonstrated with the pharmacy services. Pharmacists interpreted lung function results to identify airway obstruction for referral, making this a useful technique for review of people with asthma in the community.

• Asthma
• forced expiratory volume
• pharmacy
• program evaluation
• spirometry

Acknowledgements

The authors thank Jaya Soma (Monash University), Chehani Alles (The University of Sydney), Victoria Jarvis (The University of Queensland), and Christine Song (The University of Sydney) who contributed as project officers and data managers. The authors thank the pharmacists who worked so hard on this project and the people with asthma who contributed to our research.

Declaration of interest

The Pharmacy Asthma Care Program was funded by the Australian Government Department of Health and Ageing as part of the third community pharmacy agreement. The Pharmacy Asthma Management Service was funded by the Australian Government Department of Health and Ageing as part of the fourth community pharmacy agreement. The authors report that they have no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Supplementary material available online

Supplementary Appendix 1.