The considerable toll of respiratory diseases in terms of quality of life, disability of patients and indeed premature death [2] underlines the importance of spirometry in the detection and monitoring during the management of respiratory disease. Yet, in the past two decades, there have been specific concerns of under-utilisation in screening [3], lack of training [4] and misdiagnosis based on inaccurate results [5,6] which only serve to document the inadequacies in spirometry practice not only within Europe but on a world-wide scale.An abundance of reports [2][3][4][5][6][7][8] has propelled quality issues in the practice of spirometry to centre stage and consequently introduced a number of quality improvement strategies. High-quality spirometry relies on three key determinants: 1) documented guidelines in spirometry, 2) access to quality spirometers, and finally, 3) trained and qualified spirometry practitioners [9]. To some degree, the ERS/ATS guidelines in standardisation of spirometry [10] and availability of affordable spirometers across medical settings have directly addressed these first two factors. Further efforts implemented in the US by NIOSH (National Institute for Occupational Safety and Health), in several European countries, as well as across New Zealand and Australia through ANZSRS (Australian and New Zealand Society of Respiratory Science) have produced comprehensive training structures with supporting documents and certification criteria to endorse health professionals with a qualification to practice high-quality spirometry. There is some evidence which consistently shows that competence in spirometry is the key to quality services [7,11,12], but access to such training and assessment is relatively limited. Adopting HERMES (Harmonising Education in Respiratory Medicine for European Specialists) as a framework, this article presents the ambitious task to follow this intricate path and implement quality standards in the practice of spirometry across all of Europe.
HERMESWithin the HERMES framework, the various Task Forces for each project aim to produce uniform documents and activities to the highest standard, thus offering measurable criteria for medical training institutions [13][14][15][16][17]. Improvement in patient care and quality of life for patients with respiratory disease is the ultimate goal. A survey conducted within ERS emphasised the current gap in the content, duration and quality of spirometry training across Europe, the result of which acted as a springboard to launch the European Spirometry Driving Licence HERMES project at the annual ERS Congress 2008.Deviating from previous HERMES initiatives, the Spirometry HERMES Task Force recognised the importance of producing clear, concise and practical documents including: 1) a complete training programme, 2) guidelines for certification, 3) supporting educational materials, and 4) assessment criteria all of which form a strategy for project progression. Led by 13 representatives across Europe, each of the four project phases directl...
