Editorial
Continuing Education in Spirometry: A Light Along the Way
Formación continuada en espirometrías: una luz en el camino
a Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
b Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
c Servicio de Neumología, Hospital Universitario San Carlos, Madrid, Spain
d Fundación Caubet-Cimera, Bunyola, Islas Baleares, Spain
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Soriano" "autores" => array:3 [ 0 => array:4 [ "nombre" => "José Luis" "apellidos" => "López-Campos" "email" => array:1 [ 0 => "lcampos@separ.es" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Myriam" "apellidos" => "Calle" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "Joan B." "apellidos" => "Soriano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario San Carlos, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Fundación Caubet-Cimera, Bunyola, Islas Baleares, Spain" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Formación continuada en espirometrías: una luz en el camino" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Despite the diverse nature of chronic respiratory diseases, their clinical expression is rather limited in symptoms, so their manifestation may be overlapping. For this reason, the differential diagnosis of chronic lung disease requires additional tests that help the clinician to differentiate some diseases from others. Among these complementary studies, chest radiology (as an anatomical study) and pulmonary function tests (as functional assessment) are particularly relevant. Of the latter, spirometry has acquired a leading role as the first functional assessment in patients with respiratory diseases, since despite its simplicity, it provides comprehensive information on the lung physiology. However, although spirometry is a simple, non-invasive, reliable and safe technique, numerous studies have shown that there are problems with underuse<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and variability in the quality of spirometry performed.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The causes of this inadequate use of spirometry are multiple, and have probably contributed notably to the underdiagnosis of chronic respiratory diseases in the general population.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In this issue of <span class="elsevierStyleItalic">Archivos de Bronconeumología</span>, Roger et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> studied the use of spirometry in 65 public hospitals using a cross-sectional survey. The survey collected information on relevant aspects of spirometry, such as the number, type of spirometry, site where they were performed and information on the professionals who carried them out and their training, among others. In the results analysis, the authors observed irregular use of spirometry in these centres,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and identified the quality control of the test, inclusion of results in hospital data systems and the application of continuing education programmes as the main weak points in the centres studied. Along the same lines, a recently published national study<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> corroborates these findings, and also pointed out that the low number of spirometries performed, misuse of the bronchodilator test, inadequate calibration of the device and poor training are the main problems in the implementation of spirometry in Spain. An analysis of both studies indicates that proper continuing training in spirometry is needed to promote the performance of more of these tests and to ensure their quality.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Also in this issue of <span class="elsevierStyleItalic">Archivos de Bronconeumología</span>, Represas-Represas et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> evaluated the effectiveness of a spirometry training programme run for teams of doctors and nurses from 26 health centres. This training programme consisted of two theoretical-practical sessions two months apart with supervised monitoring of the spirometries. Through this programme, the authors evaluated 74 participants, of whom 45 completed the programme with a final evaluation after one year. The number of spirometries correctly performed and interpreted was 71% one month after starting the programme, 91% in the second month and 83% one year after having completed the initial course. Thus, the authors showed that it is possible to improve the number and quality of spirometries in Primary Care.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> These results provide a key innovation in spirometry training, namely attending a continuing education programme for various sessions that allows the knowledge acquired after the first course to be put into practice and validated over time. The study<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> also assessed the participant's knowledge one year after the first educational intervention, which enabled the authors to confirm that it remained the same as at the end of the training. However, the reality in Spain is different, since most professionals who attend a spirometry training programme do so occasionally without any subsequent follow-up.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In order for spirometries to be performed properly, at least three requirements must be met: to have quality spirometers, to establish guidelines or recommendations on spirometry and to implement training and qualification programmes for the professionals responsible for performing the test.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In this respect, the <span class="elsevierStyleItalic">European Respiratory Society</span> (ERS), aware of the impact of correct training in performing spirometries for better management of respiratory diseases as a whole, has recognised the importance of producing a quality certification for professionals who perform this test. The ERS working group <span class="elsevierStyleItalic">Harmonising Education in Respiratory Medicine for European Specialists</span> (HERMES) has proposed the ambitious task of preparing an accreditation process for this activity by creating a so-called <span class="elsevierStyleItalic">European Spirometry Driving Licence</span>.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> This accreditation process will devise uniform activities and documents that will serve as measurable criteria for the institutions that train health professionals in spirometry. The project, known as Spirometry HERMES, includes a complete training programme, certification guidelines, educational material and assessment criteria. In this way, it is hoped to create a basic competency qualification programme to define quality spirometry. The first documents are already available,<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8–10</span></a> and include information on the requirements necessary for training, the educational experience, organisation of the training programme and other organisational issues, specifications of the venues for performing the spirometry, as well as requirements for specific settings. Each of the sections into which the programme is divided has a list of criteria designed to achieve optimal quality standards that enable implementation of the programme and its surveillance.</p><p id="par0025" class="elsevierStylePara elsevierViewall">This seems to be the right time for national scientific societies to make an appeal, in order to launch teaching and training programmes, promote the correct performance of spirometries and achieve better awareness of the need to carry out quality functional examinations in all care centres that treat respiratory patients. This will enable the necessary competencies to be acquired and maintained in the long term in order to perform this technique consistently following the required quality criteria, in the interests of accessibility and equity that should govern any healthcare system.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: López-Campos JL, Calle M, Soriano JB. Formación continuada en espirometrías: una luz en el camino. Arch Bronconeumol. 2013;49:369–70.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How often is diagnosis of COPD confirmed with spirometry?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Arne" 1 => "K. Lisspers" 2 => "B. Ställberg" 3 => "G. Boman" 4 => "H. Hedenström" 5 => "C. Janson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rmed.2009.10.023" "Revista" => array:6 [ "tituloSerie" => "Respir Med" "fecha" => "2010" "volumen" => "104" "paginaInicial" => "550" "paginaFinal" => "556" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19931443" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Screening for and early detection of chronic obstructive pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.B. Soriano" 1 => "J. Zielinski" 2 => "D. Price" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(09)61290-3" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2009" "volumen" => "374" "paginaInicial" => "721" "paginaFinal" => "732" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19716965" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of COPD in Spain: Impact of undiagnosed COPD on quality of life and daily life activities" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Miravitlles" 1 => "J.B. Soriano" 2 => "F. García-Río" 3 => "L. Muñoz" 4 => "E. Duran-Tauleria" 5 => "G. Sanchez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thx.2009.115725" "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2009" "volumen" => "64" "paginaInicial" => "863" "paginaFinal" => "868" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19553233" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Encuesta de utilización de la función pulmonar en los hospitales públicos de Cataluña en 2009" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Grupo de trabajo de Función Pulmonar del Plan Director de las Enfermedades del Aparato Respiratorio (PDMAR)" "etal" => false "autores" => array:6 [ 0 => "N. Roger" 1 => "F. Burgos" 2 => "J. Giner" 3 => "A. Rosas" 4 => "R. Tresserras" 5 => "J. Escarrabill" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2013" "volumen" => "49" "paginaInicial" => "371" "paginaFinal" => "377" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A comprehensive, national survey of spirometry in Spain: current bottlenecks and future directions in primary and secondary care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.L. Lopez-Campos" 1 => "J.B. Soriano" 2 => "M. Calle" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.12-2690" "Revista" => array:3 [ "tituloSerie" => "Chest" "fecha" => "2013" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11115464" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efectividad a corto y largo plazo de un programa tutelado de formación en espirometrías para profesionales de atención primaria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Represas-Represas" 1 => "M. Botana-Rial" 2 => "V. Leiro-Fernández" 3 => "A.I. González-Silva" 4 => "A. García-Martínez" 5 => "A. Fernández-Villar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2013" "volumen" => "49" "paginaInicial" => "378" "paginaFinal" => "382" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Harmonising spirometry education with HERMES: training a new generation of qualified spirometry practitioners across Europe" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Spirometry HERMES Task Force" "etal" => false "autores" => array:5 [ 0 => "I. Steenbruggen" 1 => "S. Mitchell" 2 => "T. Severin" 3 => "P. Palange" 4 => "B.G. Cooper" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00187810" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2011" "volumen" => "37" "paginaInicial" => "479" "paginaFinal" => "481" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21357919" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adult HERMES: criteria for accreditation of ERS European training centres in adult respiratory medicine" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Loddenkemper" 1 => "T. Séverin" 2 => "S. Mitchell" 3 => "A. Belevskiy" 4 => "A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 2 | 6 |
| 2024 October | 39 | 22 | 61 |
| 2024 September | 38 | 19 | 57 |
| 2024 August | 63 | 49 | 112 |
| 2024 July | 37 | 20 | 57 |
| 2024 June | 56 | 27 | 83 |
| 2024 May | 70 | 32 | 102 |
| 2024 April | 34 | 24 | 58 |
| 2024 March | 35 | 12 | 47 |
| 2024 February | 30 | 23 | 53 |
| 2023 April | 3 | 2 | 5 |
| 2023 March | 4 | 5 | 9 |
| 2023 February | 18 | 26 | 44 |
| 2023 January | 23 | 46 | 69 |
| 2022 December | 45 | 45 | 90 |
| 2022 November | 30 | 46 | 76 |
| 2022 October | 36 | 37 | 73 |
| 2022 September | 20 | 36 | 56 |
| 2022 August | 26 | 44 | 70 |
| 2022 July | 27 | 44 | 71 |
| 2022 June | 18 | 40 | 58 |
| 2022 May | 33 | 38 | 71 |
| 2022 April | 32 | 38 | 70 |
| 2022 March | 28 | 36 | 64 |
| 2022 February | 29 | 38 | 67 |
| 2022 January | 27 | 36 | 63 |
| 2021 December | 24 | 45 | 69 |
| 2021 November | 26 | 53 | 79 |
| 2021 October | 37 | 40 | 77 |
| 2021 September | 40 | 39 | 79 |
| 2021 August | 16 | 27 | 43 |
| 2021 July | 26 | 29 | 55 |
| 2021 June | 29 | 47 | 76 |
| 2021 May | 70 | 42 | 112 |
| 2021 April | 83 | 69 | 152 |
| 2021 March | 21 | 22 | 43 |
| 2021 February | 16 | 22 | 38 |
| 2021 January | 19 | 22 | 41 |
| 2020 December | 11 | 18 | 29 |
| 2020 November | 17 | 16 | 33 |
| 2020 October | 14 | 11 | 25 |
| 2020 September | 21 | 9 | 30 |
| 2020 August | 16 | 14 | 30 |
| 2020 July | 22 | 21 | 43 |
| 2020 June | 16 | 10 | 26 |
| 2020 May | 34 | 21 | 55 |
| 2020 April | 29 | 27 | 56 |
| 2020 March | 16 | 9 | 25 |
| 2020 February | 21 | 18 | 39 |
| 2020 January | 19 | 20 | 39 |
| 2019 December | 18 | 14 | 32 |
| 2019 November | 12 | 15 | 27 |
| 2019 October | 9 | 7 | 16 |
| 2019 September | 13 | 8 | 21 |
| 2019 August | 21 | 17 | 38 |
| 2019 July | 16 | 13 | 29 |
| 2019 June | 17 | 12 | 29 |
| 2019 May | 23 | 10 | 33 |
| 2019 April | 32 | 35 | 67 |
| 2019 March | 42 | 15 | 57 |
| 2019 February | 32 | 19 | 51 |
| 2019 January | 30 | 21 | 51 |
| 2018 December | 36 | 21 | 57 |
| 2018 November | 65 | 25 | 90 |
| 2018 October | 112 | 17 | 129 |
| 2018 September | 22 | 9 | 31 |
| 2018 May | 11 | 0 | 11 |
| 2018 April | 20 | 5 | 25 |
| 2018 March | 15 | 6 | 21 |
| 2018 February | 23 | 7 | 30 |
| 2018 January | 25 | 13 | 38 |
| 2017 December | 29 | 4 | 33 |
| 2017 November | 23 | 9 | 32 |
| 2017 October | 25 | 6 | 31 |
| 2017 September | 25 | 7 | 32 |
| 2017 August | 31 | 12 | 43 |
| 2017 July | 37 | 6 | 43 |
| 2017 June | 45 | 15 | 60 |
| 2017 May | 46 | 9 | 55 |
| 2017 April | 33 | 7 | 40 |
| 2017 March | 29 | 7 | 36 |
| 2017 February | 24 | 4 | 28 |
| 2017 January | 21 | 5 | 26 |
| 2016 December | 26 | 10 | 36 |
| 2016 November | 26 | 12 | 38 |
| 2016 October | 32 | 16 | 48 |
| 2016 September | 42 | 21 | 63 |
| 2016 August | 42 | 19 | 61 |
| 2016 July | 24 | 14 | 38 |
| 2016 March | 2 | 0 | 2 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 39 | 2 | 41 |
| 2015 September | 49 | 16 | 65 |
| 2015 August | 25 | 16 | 41 |
| 2015 July | 35 | 10 | 45 |
| 2015 June | 32 | 10 | 42 |
| 2015 May | 47 | 16 | 63 |
| 2015 April | 52 | 12 | 64 |
| 2015 March | 46 | 24 | 70 |
| 2015 February | 24 | 26 | 50 |
| 2015 January | 27 | 33 | 60 |
| 2014 December | 27 | 25 | 52 |
| 2014 November | 27 | 12 | 39 |
| 2014 October | 34 | 19 | 53 |
| 2014 September | 21 | 11 | 32 |
| 2014 August | 27 | 13 | 40 |
| 2014 July | 26 | 9 | 35 |
| 2014 June | 40 | 13 | 53 |
| 2014 May | 37 | 12 | 49 |
| 2014 April | 44 | 9 | 53 |
| 2014 March | 48 | 17 | 65 |
| 2014 February | 40 | 12 | 52 |
| 2014 January | 34 | 18 | 52 |
| 2013 December | 36 | 13 | 49 |
| 2013 October | 0 | 1 | 1 |
| 2013 September | 1 | 3 | 4 |
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