A Comprehensive, National Survey of Spirometry in Spain Current Bottlenecks and Future Directions in Primary and Secondary Care

[Background] We aimed to evaluate the availability and practice of spirometry, training of technicians, and spirometer features and maintenance in Spain in both primary care (PC) and secondary care (SC) centers. [Methods] We used a nationwide, cross-sectional, 36-item telephone survey of health-care centers in Spain to target the technician in charge of conducting spirometries in PC and SC centers where outpatient respiratory patients are routinely evaluated. The questions surveyed for resources, training, spirometer use, bronchodilator tests, and spirometer features and maintenance. [Results] Of a total of 1,259 centers screened, 605 PC centers (21.2% of the PC centers in Spain) and 200 SC centers (24.9% of the SC centers in Spain) were surveyed. The response rate was 85.4% for PC centers and 75.1% for SC centers. All together, 19% of screened centers did not have a spirometer or were not using it. The number of spirometers per center and spirometries conducted per week was higher in SC centers than in PC centers (P < .001). Most centers received training for conducting spirometries, but this was periodically done in < 40%. Most centers used two inhalations of salbutamol for the bronchodilator test, but the international criteria of a positive test was considered only in 55.8% of PC and 52.8% of SC centers. Calibration of the spirometer was never done in 10.5% of PC and 3.1% of SC centers. [Conclusions] This survey maps for the first time, to our knowledge, the current situation of spirometry in Spain, identifying bottlenecks and suggesting future directions applicable in both PC and SC centers and elsewhere.The authors have reported to CHEST the following conflicts of interest: Dr Soriano received grants from GlaxoSmithKline plc in 2011 and Chiesi Ltd in 2012 through his home institution and participated in speaking activities, on an industry advisory committee, or in other related activities sponsored by Almirall, SA; Boehringer-Ingelheim GmbH; Pfizer, Inc; Chiesi Ltd; GlaxoSmithKline plc; and Novartis Farmacéutica, SA during the period of 2010 to 2012.Peer Reviewe