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Interpretation moves from percentage of predicted to z-scores. Bronchodilator responsiveness moves from 12% and 200 mL from baseline to more than 10% of predicted. Operator competency becomes a defined training and refresher cycle rather than a one-off course. And in Queensland, mine dust surveillance now runs on a third-version pathway that assumes all of the above. Nothing here is new evidence — it is new thresholds and new expectations, and reports are already arriving with both old and new numbers on them.
The three documents
| Document | Published | What it governs |
|---|---|---|
| TSANZ SPC01 Technical Standards for Spirometry in Australian Primary Care | 2026 | The test and the equipment — reference values, interpretation, bronchodilator responsiveness, quality control, reporting.1 |
| TSANZ SPC02 Standards for Training and Maintaining Competency in Spirometry | January 2026 | The people — initial training, refresher intervals, competency levels, workplace assessment. Replaces the earlier Standards for Spirometry Training Courses (2022).2 |
| RSHQ Mine Dust Lung Disease Clinical Pathways Guideline Version 3.0 | October 2026 | The Queensland statutory surveillance pathway followed after an abnormal screening result.3 |
They are best read as one change rather than three. SPC01 sets thresholds that only mean anything if the operator can obtain a technically valid test, which is what SPC02 addresses; and the Queensland pathway requires providers approved against both.2,3
What changed, and what to do differently
| What | The old rule | The 2026 rule | What to do differently |
|---|---|---|---|
| Reference values | Percentage of predicted, often with mixed or unstated reference equations. | GLI 2012 reference values, interpreted by z-score.1 | Check which equations your spirometer is using. A report without a named reference set cannot be interpreted to the standard. |
| Defining abnormal | A fixed FEV1/FVC ratio below 0.70. | Ratio below the lower limit of normal — a z-score below −1.65 (the 5th percentile).1 | Stop reading 0.70 as a diagnosis. It over-calls obstruction in older patients, whose ratio falls naturally with age, and misses it in the young.1 |
| Grading impairment | Percentage of predicted FEV1 in tiers — 70%, 60%, 50%, 35%. | Z-score tiers: mild −1.65 to −2.5, moderate −2.51 to −4, severe below −4.1.1 | Use the z-score tiers for impairment. Percentage of predicted still belongs in disease-specific staging — GOLD grades in COPD, for instance — and those are unchanged.1,4 |
| Bronchodilator responsiveness | Increase of ≥12% and ≥200 mL from the patient's own baseline. | Increase of more than 10% of the predicted value in FEV1 or FVC. The from-baseline methods are no longer recommended.1 | Report pre- and post-bronchodilator FEV1 and FVC and express the change as a percentage of predicted. Expect printouts to still show the old rule. |
| Reference category for Aboriginal and Torres Strait Islander patients | Variable, and often not recorded. | “GLI Other”, unless the GLI Global dataset is in use, applied consistently across serial tests.1 | Record which category was used, and flag any change on the report — an unnoticed switch between categories looks exactly like real decline.1 |
| Reporting software | Whatever the device shipped with. | Must be able to calculate and display z-scores, lower limits of normal and bronchodilator responsiveness consistently with SPC01.1 | This is a procurement question, not a clinical one. A spirometer that cannot be updated to report z-scores has reached the end of its useful life. |
| Initial operator training | A course, with no specified minimum. | At least 10 hours, of which at least 60% is practical, hands-on training — whatever the delivery format.2 | Ask a training provider for the practical-hours split before booking. Format alone does not satisfy the standard. |
| Staying competent | Effectively open-ended once trained. | Refresher within 12 months of initial training and workplace assessment, then at least every three years. Workplace portfolio assessment within 3–4 months of the workshop.2 | Diarise it as a cycle. SPC02 also discourages competency assessment without a recent refresher, on the grounds that it gives false reassurance.2 |
| Test volume | Not addressed. | Progression from Advanced Beginner assumes roughly three patients per week, with workplace mentoring available.2 | A service that tests occasionally should plan for more support, not less. |
| Queensland mine dust surveillance | Version 2 of the pathway. | Version 3.0 (October 2026). Triggers are based on pre-bronchodilator results; chest X-rays are read by two certified readers using the ILO classification with independent adjudication; spirometry must be by an RSHQ-approved provider working to the TSANZ standards.3 | Check provider approval before offering statutory surveillance. Where a technically good test cannot be obtained, repeating in four to six weeks may beat acting on a poor one.3 |
The one that catches people out
A change of more than 10% of predicted is not the same as a 10% change from baseline, and SPC01 says so directly.1 A patient with small lungs can clear the old percentage threshold on a tiny absolute gain; a patient with near-normal predicted values can improve substantially and still not reach it. Converting one to the other in your head does not work — the denominator is different.
Two further points worth carrying into interpretation. Responsiveness in FVC rather than FEV1 may reflect a reduction in air trapping, and is read in that light.1 And BDR remains a single measurement on a single day: a negative test does not exclude asthma, and a positive one does not confirm it.
What has not changed
Worth stating plainly, because a change of standard invites over-correction:
- Lung function severity is still not disease severity. SPC01 is explicit: symptoms, functional capacity, imaging and comorbidities all belong in the assessment.1
- Lung function sits on a continuum, so severity labels need care near their boundaries — a z-score of −2.5 and one of −2.6 are not two different diseases.1
- Disease-specific staging systems remain in use for their own purposes, including percentage of predicted where that is how the system is defined.1,4
- The physiology is unchanged. Obstructive, restrictive and mixed patterns mean what they always meant; only the thresholds that define them have moved.
Where to read the detail
- Spirometry — the test itself, the z-score and BDR tables in full, and the four classic patterns.
- Spirometry Service & Operator Standards — equipment, quality control, the six competency levels and cultural safety.
- Mine Dust Lung Disease Screening — the Queensland pathway, who pays, and what a diagnosis means for work.
- Complex Lung Function Testing — gas transfer and volumes, where the pathway escalates beyond spirometry.
References & evidence base
- Thoracic Society of Australia and New Zealand. SPC01: TSANZ Technical Standards for Spirometry in Australian Primary Care. TSANZ; 2026.
- Thoracic Society of Australia and New Zealand. SPC02: TSANZ Standards for Training and Maintaining Competency in Spirometry for Australian Primary Care. Version 1.0. TSANZ; January 2026.
- Resources Safety and Health Queensland. Mine Dust Lung Disease Clinical Pathways Guideline. Version 3.0. Brisbane: RSHQ; October 2026.
- Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management and Prevention of COPD. GOLD; 2026.
References are numbered in citation order (Vancouver/BMJ style) and were current at the time of writing. Guidelines are living documents — verify against the latest version before clinical use.
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