Challenges faced by adolescents and lung function technicians in Anuradhapura district, Sri Lanka, during spirometry: a qualitative study.

Spirometry is the gold standard test for diagnosing airway disease. However, conducting spirometry in adolescents (13-14 y of age) is challenging because technicians should build a good rapport and maintain the technical rigour required in adult testing. This study investigated the challenges in spirometry assessment of adolescents with severe asthma. This was a qualitative descriptive study conducted in the Anuradhapura district, Sri Lanka from February to April 2023. Spirometry was conducted according to standard American Thoracic Society/European Respiratory Society guidelines. Three instructors with adequate knowledge but no prior experience conducted spirometry in adolescents, while two independent researchers observed the participants, followed by in-depth interviews. Data were collected until data saturation was achieved. Thematic analysis was used to analyse the experiences and perspectives of lung function technicians and participants. Data saturation was achieved with 15 adolescents (7 male, 8 female). Two (13.3%) participants showed airway obstruction, while one (6.67%) had significant reversibility. Demonstration and simultaneous execution to train the respiratory manoeuvres improved the responses, but the test was tiring for the trainee instructor. Most adolescents found the procedure exhausting, and the trainee instructor's self-confidence improved the adolescents' performance. The study underscores the need for specialized training required to conduct spirometry in adolescents and better awareness for adolescents and parents of lung function testing.