Immediate on-screen quality grade reporting is associated with improved spirometry quality.

<bold>Introduction:</bold> Recent ERS technical standards have formalized the assessment of spirometry quality. There is little research on the utility of the spirometer itself to improve quality. In 2020 we installed a new spirometry system which provides intra-session automated quality-control (QC) feedback to the technicians. <bold>Methods:</bold> We extracted 300 consecutive spirometry tests each from the older system (ZAN600, no-QC group) and the new system (COSMED QuarkPFT, automated-QC group). An investigator assessed each spirometry attempt for artifacts and acceptability, and then QC-graded the test session from A-E. <bold>Results:</bold> After transition from no-QC to automated-QC: Acceptable tests/session improved from 2.0 to 3.0; Total artifact-free testing sessions increased from 35% to 59% (OR 2.64 95%CI 1.89-3.66); In the no-QC group , 32% of FVC tests were graded E and 34% were graded A. In the automated-QC group, E-grade tests were reduced to 5% and grade A increased to 66%. Findings with FEV1 were similar. Automated QC feedback was associated with OR 3.61 95%CI 2.55-5.16 (FVC) or OR 3.60 95%CI 2.19-4.35 (FEV1) of obtaining an A-grade spirometry. Inter-observer agreement was excellent between the automated-human QC (kappa 0.83-0.84) and very-good between (kappa 0.66-0.75) <bold>Interpretation:</bold> Intra-session QC feedback to technicians was associated with significant improvement – reduced artifacts, improved spirometric values and quality control scores