Hi. My COPD nurse phoned this morning and said she wanted to do a COPD annual review by phone. I declined, saying there is too many visual elements involved to do such a review by phone alone. (my GP practice only allows video interviews by the trainee doctors). In fairness, he is arranging for a face to face review. But when I mentioned spirometry, he said this is no longer carried out in GP practice. Does anyone know about this?
Annual COPD review: Hi. My COPD nurse... - Lung Conditions C...
Annual COPD review
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micox
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33 Replies
•
Yes at the moment they’re not doing spirometry at GP practices during the pandemic. Take care xxx
• in reply tosassy59
That begs the question what the heck have they been doing! In my case he has packed up and gone home, retired, so I don't have a doctor now, or if I do I don't know who it is. Madness! xxx
sassy59• in reply to
You must have a doctor Don, he’s just hiding for now. Pete’s not seen a doctor for nearly two years. I think over the phone chats or online will be the way forward. Strange times dear friend. Xxxx❤️
60% are now part time as they earn much more doing locum and private.
Hope you're both keeping as well as possible
All good and hope you’re doing well Brian. Xxx😘
As an aerosol generating procedure (AGP), spirometry is classed as a very high risk for covid transmission, and is described by the CQC as being currently ‘on pause’ in primary care settings like GPs. Even in hospitals, there have been significant restrictions on performing spirometry throughout the pandemic, with it only being done where there is a clear clinical necessity and no appropriate alternative (like issuing some patients who need to regularly check their fev1 with home spirometry devices, which the nhs/some respiratory teams have done for certain patient groups). Talking to the respiratory physiologists at my daughter’s hospital over the last few days, these restrictions have definitely eased a fair bit since February, and they are apparently looking at reintroducing spirometry more widely, but I’m guessing it may take quite some time for this to filter back to GP services due to the extent of infection control required to test each patient. In a hospital ward environment, it’s currently only to be done in a closed room, with staff in full PPE (gowned, double gloved, respirator masked and visored), and with the exception of the patient, no one being able to enter the room again for an hour afterwards unless in the same full PPE, in addition to fully disinfecting the spirometer. That works in an inpatient’s room, if they have a room to themselves like my daughter, and you only have one or two patients to test, but is logistically almost impossible at a clinic or GP practice level.
sassy59• in reply to
Great explanation Charlie xxx👍💛
micox• in reply to
That's a tremendous explanatory response Charlie. Thank you.
• in reply to
I think you will find that most gave up the spirometer tests well before the pandemic. What annoys me is the flippant way they offer quick chats on the phone in place of face to face appointments. Especially with the elderly hard of hearing trying to understand docs who struggle with the English language. No me, my doctor seems to have got fed-up with it all and retired.
ladyn• in reply to
Why don’t they take the patients outside and do the test?
• in reply toladyn
Not all hospitals have outside space beyond the street entrance, for starters, particularly in inner cities. But beyond that, privacy would be the first thing: not sure it would be appropriate or that many people would want to undertake medical tests in view of others, and particularly not tests that may make them cough sputum up, as can be the case for people with productive conditions when they do spirometry. Even if you could take them somewhere private, though, there’s the possible effect of pollution and airborne contaminants on the results, insects flying about, other people generally, distractions (spirometry is actually quite technical to do well, you have to concentrate to ensure good, consistent technique). However small, there would potentially be a risk of coming into contact with covid, and unless you were doing it in the middle of a field, there would be a risk of contaminating surrounding objects and surfaces if the patient was covid positive and you didn’t know that yet. The staff would still need to be in PPE to perform the test to mitigate that transmission risk to them as individuals, as they have to stand quite close to operate the spirometer, and the spirometer would still need to be fully decontaminated each time. Ultimately, though, this is a test designed to analyse air flow, so environmental and weather factors like wind are not things you want to introduce, either: I’d anticipate the odds of them impacting on the results would be quite slim, but when major treatment decisions are made in some patient groups based on changes in fev1 - including keeping them in hospital for longer - you want to be as sure as you can be that you’re not introducing unnecessary, potential sources of error.
Loopylorre• in reply to
I totally understand all you have just explained about the spirometry tests, but, as a comparison every time I went for my Covid vaccine masks were worn but no ppe, so surely the risk of catching/ spreading Covid is exactly the same as going for a spirometry test, I don’t understand the difference, especially when Boris apparently said on the tv some time ago surgery’s should now be more face to face, everything is very contradictory when comparing one thing to another, we all had to use the same surgery or wherever you went for the vaccine, surely risks are the same or am I missing something? Gets very frustrating 😊
You are not comparing like with like. People breathe normally when being vaccinated whereas they are blasting out possible contamenents (sp?) when doing spirometry.
• in reply toLoopylorre
The difference is aerosol generation. Like most respiratory illnesses, covid is transmitted by aerosol: the virus is carried on microscopic liquid particles from someone’s respiratory tract. There is a very small amount of aerosol spread from normal breathing, which is part of why asymptomatic spread has been a problem and close contact with people outside of your household has been advised against during the pandemic, but it’s generally force applied to the airways such as when coughing (and including singing and shouting) that generate significant amounts of aerosol. Anything that increases the likelihood of force being applied to the airway therefore massively increases the risk of covid transmission, so the list of medical AGPs that should be limited, or only undertaken with certain safety measures in place, includes anything that we know leads to changes in respiration and/or coughing, such as chest physio, spirometry, intubation, suction etc., or other avenues of aerosolisation such as high speed dental drilling or even certain post mortem tests.
Spirometry requires forceful emptying of the lungs, with patients exhaling for as long as possible, and as hard as possible, into what effectively amounts to an open ended tube. The act of exhaling forcefully in and of itself generates significant amounts of aerosol, which then ends up in the room and landing on anything within 2 or 3 metres of the person doing the test, where any virus remains until it dies or is cleaned off. People also quite commonly cough at the end of a spirometry blow, thus increasing the aerosol generation even further. This is why even without covid, cross infection with spirometers is a general risk between certain patient groups and requires strict cleaning protocols to prevent bacteria transmitted by aerosols from being shared between patients.
Spirometry is still being done at the the lung centre in Wythenshawe hospital,full ppe was not deemed neccessary on my recent visit though the room and equipment were cleaned and vented for 30mins between patients and only one patient was seen at a time wheras previuosly 2 or 3 patients would have been tested in the same room simultaneously. 
I have a lung function test booked for next week at my local hospital. But I have to go to Oxford for the covid test!
Mine is on 23rd this month, phone call only. No spirometry because it involves forced expirations a real good way to spread the virus if patients are infected. Most of us are not but the surgeries cannot be too careful. In a way it is safeguarding as best as can all patients who may visit the surgery including staff.
Sops• in reply to
Mine is on Friday, phone call only also, but am seeing my GP later the same day as some problems have arisen from X-rays taken.
Hi my respiratory app is also by phone next month I had a chat with the physio nurses who said no spirometry at the hospital either until restrictions ease
My docs seem keen to keep people out of the practice still but I do hope they are going to keep up spirometer tests as for some of us it’s a very long day getting to the nearest hospital. Love to hear what others say too .
The practice nurse phoned to do my annual health check a few days ago. Asked me some questions e.g. Do you cough? Do you have mucus? Replied no and no. She was happy to take my word for blood pressure readings and weight. I could have invented all the answers. She then said I should have bloods taken to check kidney, liver and cholesterol. I thought about this later and I have cancelled the appointment. If it wasn’t important enough to have done last year I doubt the intrinsic value of it as a routine test. My kidneys and liver seem to be doing their job and I wouldn’t take statins anyway. If I’m unwell I’ll make an appointment with a doctor, a telephone one obviously!
These annual health checks are a tick box exercise that I think they may get paid extra for. I was doubtful of their worth even when done face to face, but by telephone.......?
I feel exactly the same teenieleek , a total waste of time!!!
Well I had the test 6 months ago at our surgery in the North Midlands where I live. Ridiculous the way we are being mis treated and a simple test too
For many years I had spirometry tests every 6 months. at my local surgery. We moved north and on my first appointment at the new medical centre, with practice nurse, which was nearly 4 years ago, he said they no longer do spirometry testing, not necessary!!!! So I may never know whether it's deteriorated or not. No support for COPD patients.
The same army GP practice. They do it by Q&A about how you feel, how many exacerbations and tte sound your voice/breathlessness etc. I queried this with my CCG just last month at a meeting and was told it is standard practice now. They also said the spirometry machine did not give a more accurate picture than human knowledge so it is abandoned.
I've never seen the point to spirometry for COPD other than for diagnosis where it is crucial and for a worsening of symptoms or testing for other potential procedures such as valves. The readings are only going to go one way and there is no medication that can alter the progression of the disease other than smoking cessation.
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