Many documents over the years have offered guidance on how to perform or interpret spirometry and yet despite this it is still an area of much confusion and controversy. A guide to performing quality assured diagnostic spirometry1 was the first overarching document by key stakeholders to outline the minimum requirements for performing spirometry. The section consisting of the ‘top ten tips’ was published to suggest ‘how to’ look at a spirometry trace and check if it is appropriate for interpretation. The remainder of the document is advisory as to the standards for equipment, verification, cleaning and an overview of how to undertake spirometry. For those new to this subject is should be their ‘how to’ guide.
As the author of the original top ten tips, and having used them frequently for training sessions, it was apparent there were elements of them that were no longer current and needed to be revisited. Most machines now utilise the NICE 20102 guidance as to severity of obstruction whereas in the initial publication there was still confusion around the change from the original 2004 chronic obstructive pulmonary disease (COPD) guidelines. As NICE 2010 now reflects GOLD 20203 this is less of a concern. The top ten tips (see Box 1)have been seen as a systematic approach to spirometry since the publication of the guidelines in 2013.