Association between stress levels and quality of spirometry test performance

<bold>Introduction:</bold> The correct performance of spirometry requires the patient's cooperation. The influence of stress on spirometry performance quality remains underexplored. We aimed to explore the relationship between stress and spirometry performance. <bold>Methods:</bold> This cross-sectional study included patients referred to our department from September2023 to January2024. All patients completed the Perceived Stress Scale(PSS) and underwent spirometry. We hypothesized that incorporating maneuver quality criteria into a single score would allow a more accurate assessment of patients’ cooperation. Therefore, we defined the Cooperation Index(CI) including 5 items: 1)A good start 2)A satisfactory duration of exhalation 3)Maximal effort during the maneuver 4)Absence of cough and flow variation during the maneuver 5)Reproducibility between the two best maneuvers. Each item was scored 0 if the criterion has not been met and 1 if the criterion has been met. The total CI was calculated by adding the score of each item. Then, the study population was divided into two groups: G1 with CI=5 and G2 with CI<5. <bold>Results:</bold> We included 121 patients of whom, 45.5% had asthma and 25.6% had COPD. The mean age was 51.45±10.93 years with a female predominance(56.2%). G2 included 46 patients distributed as follows: 2 with CI=1; 12 with CI=3 and 32 with CI=4. These patients had higher PSS score(G2:27.73±5.84 vs G1:24.16±6.58 ; p=0.003) and a greater prevalence of women (G2:67.39% vs G1:49.33% ; p=0.039). Moreover, CI was correlated with PSS score(r=-0.277; p=0.002) but not with age nor with spirometric measurements. <bold>Conclusion:</bold> Our findings highlight the importance of considering psychological factors in functional respiratory assessments.