Abstract

Background: Access to spirometry testing for COPD diagnosis in primary care varies across the UK, with some areas without access to spirometry at all. New delivery models such as Community Diagnostic Centres have been introduced to mitigate disparities in provision. However, there is little contemporary evidence regarding how spirometry services for COPD diagnosis are delivered and experienced.
Aims/Objectives: To gain in-depth insights into clinicians’ experiences of current COPD diagnostic pathways, barriers and facilitators to spirometry delivery, and views on potential diagnostic innovations to support COPD diagnosis in UK primary care.
Methods: Semi-structured qualitative interviews were conducted with healthcare professionals involved in COPD diagnosis within and from UK primary care. Participants were purposively sampled from respondents to a national survey. Interviews took place October 2025 and January 2026 and were analysed thematically.
Results: 28 participants were interviewed, predominantly nurses (n=17) and GPs (n=6) but including pharmacist, physiologist and hospital consultant representation. Participants described respiratory care as an area that “just isn’t sexy”, resulting in de-prioritisation at an organisational level, inconsistent funding and skilled workforce shortages with insufficient interest in developing a special interest within primary care. Many viewed spirometry as technically complex, emphasising that “spirometry is only as good as the person doing it”, with concerns regarding performance, interpretation and quality assurance. Access to diagnosis was perceived to depend heavily on local expertise, creating marked geographical variation in service provision. While clinicians were receptive to diagnostic innovation, they emphasised that any alternative would need to be “fast enough to impress the GPs” as well as accurate, acceptable to patients and capable of integrating into routine workflows.
Implications: Clinicians described spirometry as a challenging diagnostic test for both patients and professionals, affecting access to timely COPD diagnosis. They highlighted the need not simply for additional funding for spirometry provision, but for better ways of delivering diagnostic services capable of identifying patients earlier in their disease journey, when intervention may have greater impact. Clinicians saw considerable potential for diagnostic innovation but emphasised future technologies must be practical, acceptable to clinicians and patients, and capable of improving accessibility and efficiency without compromising diagnostic confidence.