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Spirometry should be performed by a healthcare professional who has had appropriate training and who has up-to-date skills.

The use of post-bronchodilator spirometry should be supported by quality control processes.

To ensure early diagnosis, spirometry should be done in primary care when a person presents with a risk factor for COPD (which is usually smoking) and one or more symptoms of COPD.

a) Evidence of local arrangements and written clinical protocols to ensure that people aged over 35 years presenting with a risk factor and one or more symptoms of COPD have post-bronchodilator spirometry. Quality and Outcomes Framework indicator COPD002: The percentage of patients with COPD in whom the diagnosis has been confirmed by post-bronchodilator spirometry between 3 months before and 12 months after entering on to the register.

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available.

Healthcare professionals ensure they remain up to date with training and competencies in performing and interpreting post-bronchodilator spirometry.

Assessing inhaler technique should happen at the first prescription once a person has been taught the correct technique, and then be reassessed regularly (for example, at their annual review, if their treatment changes or after an acute exacerbation) throughout the duration of a person’s treatment in primary, community and secondary care services.

a) Evidence of local arrangements and written clinical protocols to ensure that people with COPD who are prescribed an inhaler have their technique assessed at the start of treatment and then regularly during their treatment.b) Evidence of local arrangements and written clinical protocols to ensure that healthcare professionals in primary, community and secondary care services are trained and competent in teaching inhaler technique.

Service providers (primary care services) ensure that quality-assured post-bronchodilator spirometry is carried out in people aged 35 years and over who have a risk factor and one or more symptoms of COPD, to confirm diagnosis of COPD.

Service providers ensure that healthcare professionals are trained and competent in performing and interpreting post-bronchodilator spirometry.

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