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Comprehensive quality control for pulmonary function testing: it's time to face the music.

Every day in pulmonary function laboratories and clinics around the world, efforts to ensure the quality of spirometry testing begin, and all too often end, with a few strokes of a 3-liter calibration syringe. Of course, validating a spirometer’s accuracy and precision is a universal practice and is described in great detail in the American Thoracic Society/European Respiratory Society (ATS/ ERS) spirometry guidelines.1 However, having a finelytuned instrument, be it a spirometer or a violin, doesn’t ensure a virtuoso performance once the curtain is raised. Indeed, musicians require years of training and practice to achieve virtuoso status. Even after the violinist has mastered his instrument, there is feedback on the performance. Feedback and criticism, whether desired or not, come from the orchestra conductor, peers, and, of course, those in the audience with a keen ear and the unwillingness to bestow effusive applause for a less than sublime performance. Indeed, the criticism a musician receives, when used properly, accelerates learning and ascension to elite levels of performance. The positive influence of feedback and criticism on performance also holds true for pulmonary function technicians and others who conduct spirometry. Coincidently, John Hutchinson, who invented a water spirometer and introduced the term “vital capacity,” was an accomplished violinist.2