Knowledge, attitudes, and practices of primary healthcare physicians toward spirometry use in Saudi Arabia: a national cross-sectional study

Background Spirometry is considered the gold standard for diagnosing and monitoring chronic respiratory diseases such as asthma and COPD. However, its integration into primary healthcare (PHC) remains limited worldwide. In Saudi Arabia, little is known about PHC physicians’ knowledge, attitudes, and practice patterns regarding spirometry. Therefore, in this study we aimed to evaluate the knowledge, attitudes, and practices (KAP) related to spirometry among PHC physicians in Saudi Arabia, with the goals of identifying gaps and guiding future educational and policy efforts. Methods We conducted a national cross-sectional survey of PHC physicians from all regions of Saudi Arabia. A modified, expert-reviewed questionnaire was used to assess knowledge, attitudes, practice patterns, barriers, and awareness of international guidelines. Descriptive statistics were used to summarize the data, whereas the barriers regarding the use of spirometry were compared between physicians with and without access to a spirometer. Results A total of 586 physicians participated, representing a broad geographic distribution. Although >75% recognised the importance of spirometry for diagnosing asthma and COPD, the actual utilisation was low. Only 27.0% of PHC physicians reported using spirometry for COPD diagnosis and 25.9% using it for diagnosing asthma. Reported barriers varied by access. Lack of equipment predominated among those without a device (76.3%). Among those with a device, limited staff support (35.2%) and restricted access to the machine (41.8%) predominated. Even in this group, use was minimal, with a median of 2 (IQR 1–5) tests per week. Conclusion Despite widespread recognition of its importance, spirometry remains underused by Saudi PHC Physicians. Addressing barriers through equipment provision, workforce training, and clear national guidelines is essential to strengthening respiratory care delivery and improving early diagnosis. Clinical trial number Not applicable.