Original Title: Maladie pulmonaire obstructive chronique : administration d’un test de spirométrie pré/postbronchodilatateur à de fins diagnostiques, et interprétation des résultats

Authors' objectives: A subsequent request from the Ministère de la Santé et des Services sociaux now aims to support health professionals in conducting the test and interpreting spirometry results, given the variability in expertise at the primary care level and the importance of the quality of the maneuvers, analysis and clinical interpretation for ensuring an accurate diagnosis.

Authors' results and conclusions: RESULTS (#1 PERFORMING HIGH-QUALITY SPIROMETRY TO MAKE AN ACCURATE DIAGNOSIS): Spirometry is safe and poses no risk of harm to a person’s health. However, it is important to establish a clear protocol for emergency measures to be taken − especially in settings with no physician on site − in the event of bronchospasm, syncope, pneumothorax or chest pain. (#2 ANALYZING SPIROMETRY RESULTS: GOING BEYOND THE NUMBERS): Using, in primary care, a cutoff value of 0.7 for the FEV1/FVC ratio and 80% of the predicted FEV1 value makes it easier to analyze the results by taking symptoms and risk factors into account, which reduces the risk of misdiagnosis. However, unlike the lower limit of normal (LLN) method, this approach carries a slight risk of under- oroverdiagnosis, particularly among individuals under 50 and over 80 years of age, respectively, especially those with mild respiratory impairment. (#3 INTERPRETING SPIROMETRY RESULTS: KEY ELEMENTS FOR AN ACCURATE DIAGNOSIS): Pre-/post-bronchodilator spirometry is highly effective for diagnosing COPD, where a post-BD FEV₁/FVC ratio of less than 0.7 in a clinically suggestive context confirms obstruction. However, it is less useful for diagnosing asthma. A restrictive pattern may be suspected when the forced vital capacity is reduced, although it is not possible to differentiate between a neuromuscular or parenchymal issue and pseudorestriction due to hyperinflation. (#4 REDUCING THE ENVIRONMENTAL FOOTPRINT OF SPIROMETRY TESTING: CONCRETE MEASURES): Single-dose inhalers are in widespread use in clinical practice, primarily because of safety-, dose accountability- and infection control-related concerns. CONCLUSION: Various courses of action are suggested, including the following: • Promote the implementation of recommendations for the management of COPD, develop skills through education and training, support clinicians in following persons with COPD, promote access to a spirometer (and single-use components) in primary care settings, define the local conditions required for initiating salbutamol in accordance with the current statutes and regulations, such as the type of prescription required, whether collective, individual or for professional use.

Authors' methods: A manual literature search was conducted on the websites of learned societies specializing in respirology and of professional associations and orders and healthcare institutions in Québec for clinical practice guidelines and clinical tools for performing spirometry and interpreting the results, and for updates to guidelines identified during the work done previously. Medical reference works and clinical tools on spirometry were searched for as well to support the development of the clinical tool for interpreting spirometry results. A scientific professional selected the documents, while two professionals participated in the data extraction process and in determining their methodological quality.

Project Status: Completed

Year Published: 2026

URL for published report: https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Usage_optimal/MPOC_AdminSpiro_pre_postbroncho_GN.pdf

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)