The burden of respiratory diseases in Nigeria is enormous [
1] with varying published prevalence of respiratory illnesses that have lung-function complications. These include pneumonia and its various complications, tuberculosis [
2], asthma [
3], chronic obstructive pulmonary disease (COPD) [
4] as well as diseases that have lung-related co-morbidities like sickle cell anemia (SCA) [
5], and HIV [
6] which have attendant restrictive (interstitial) or obstructive residual effects on the lung. Furthermore, associated environmental inhalations that affect the lung, such as environmental tobacco smoke exposure [
7], use of biomass fuels for cooking [
8], gas flaring activities, and air pollution [
9] also abound in Nigeria. Regarding the ability to diagnose their effect on the lungs and thus make policies that could reduce associated morbidities, it is important that the health worker be versed in the use of lung-function assessment tools like spirometry. Furthermore, other equipment for lung-function assessment (plethysmograph, gas diffusion/dilution measurements, fractional exhaled nitric oxide FeNO equipment), due to cost, are not readily available in Nigeria, while the more available peak flow meters, have diagnostic limitations. The Computed tomography of the chest (Chest CT), is expensive and not routinely requested. Where competency for the use of spirometer is enhanced, respiratory disease burden can at least be objectively quantified and referrals made appropriately to pulmonologists [
3,
10]. Several studies have reported a global inadequacy in the knowledge and use of spirometry for the diagnosis and treatment of respiratory diseases such as COPD and asthma [
11].
Although spirometry is relatively easy to carry out, its clinical utility is however partly dependent on the competency and knowledge of the personnel performing and interpreting the test results [
12‐
16]. Where the necessary competency for the use of spirometer is lacking, disease burden cannot be objectively quantified with resultant misdiagnosis and mismanagement of such respiratory diseases like asthma and COPD, as inappropriate interpretation of spirometric values would mean a different diagnosis and a different treatment pathway [
17]. In other instances, patients with dyspnea and wheezing have been diagnosed with cardiac diseases leading to people in low-and middle-income countries (LMIC), spending scarce resources on investigations like 2-D Echo and diagnosis of asthma eventually confirmed after proper spirometry is done [
18]. Other asthma mimics have also been correctly diagnosed by deploying spirometry [
19]. Furthermore, competency in spirometry will also ensure detection and reduction in disease-related morbidity such as in children with HIV or SCA where early lung-function assessments during childhood identify early those who require long-term follow-up. Studies have therefore highlighted the need to improve spirometry knowledge and training through spirometry workshops, as well as improve quality assurance to meet acceptable standards [
20‐
22].The best approach would also include assessing competence at end of training which should include both knowledge base and skills acquisition assessment, done in stages [
21,
22]. The appropriate use of the spirometer will therefore requires quality training of the health personnel. In both private and public health facilities, spirometry performance is not usually limited to spirometry technicians [
23].On the contrary, in Nigeria and other LMIC, the test procedure is carried out by doctors, nurses, and other health workers who sometimes may not have received any formal spirometry training. In the developed world like the United States, technicians who perform spirometry test compulsorily complete a nationally approved course with at least a minimum of 3-yearly refresher courses [
20,
21,
24]. In New Zealand, Australia, and South Africa, training courses with international accreditation for spirometrists or anyone who does reliable spirometry also exists [
20,
25,
26]. The American Thoracic Society (ATS)/European Respiratory Society (ERS) recommend that spirometry should be performed by trained, competent, and experienced personnel. They should be able to correctly teach participants how to assess the correct performance of the spirometry test by patients and the quality of the test result and should form the core of the training team [
21].There has been a few formal training of Nigerian health workers on spirometry, most of which have been with the collaboration of funded international agencies like Pan-African Thoracic Society (PATS)/MECOR courses and Breathe Africa. Similarly, a South African training body-Spirometry Training Services Africa (STSA) has held several spirometry courses and workshops in many parts of Africa [
26], and recently undertook a training course in South-West Nigeria. No such course has taken place in South-East Nigeria and other regions of Nigeria, and there are no known regular formal indigenous training courses with re-certification opportunities in Nigeria. The Little Lung Africa respiratory team, made up of trained and certified spirometrists (see attached
supplementary file), thus undertook a one-day hands-on spirometry training workshop, with testing of knowledge following theory and hands on session (phase 1) and a future specific skills assessment planned (phase 2). The team used a similar curriculum as the ERS and STSA [
21,
24,
26] to create a ripple effect on the knowledge and application of spirometry and to evaluate the impact of this limited one-day intervention, while showing the need for a funded re-certification course domiciled in Nigeria.