Testing Considerations by Condition including asthma, chest tightness, COPD

1.) ASTHMA

Initial Evaluation:

Pre & Post-Bronchodilator Spirometry testing is useful for demonstrating airway obstruction reversibility, central in establishing an asthma diagnosis. An absence of reversibility may lead to seeking alternative explanation for wheezing, cough, or stridorus breath sounds.


For monitoring

Spirometry, as well as measring the Fractional excretion of exhaled Nitric Oxide (FeNO) are useful for defining degree of control, exacerbation, and/or response to therapy. Consider testing with symptom changes, after changes in therapy, otherwise annually.


Consider also:

Determination of DLCO is generally considered optional but could identify COPD, or clarify a COPD component.


Methacholine Challenge Test (MCT) if PFTs are normal or nearly normal and question about diagnosis remains.



Tests in bold offered at pft at ALLERGY & ASTHMA


return to top

2.) CHEST TIGHTNESS

Initial Evaluation:

Pre & Post-Bronchodilator Spirometry testing is useful for demonstrating airway obstruction reversibility, central in establishing an asthma diagnosis. An absence of reversibility may lead to seeking alternative explanation for wheezing, cough, or stridorus breath sounds.


For monitoring

Spirometry, as well as measring the Fractional excretion of exhaled Nitric Oxide (FeNO) are useful for defining degree of control, exacerbation, and/or response to therapy. Consider testing with symptom changes, after changes in therapy, otherwise annually.


Consider also:

Determination of DLCO is generally considered optional but could identify COPD, or clarify a COPD component.

Methacholine Challenge Test (MCT) if PFTs are normal or nearly normal and question about diagnosis remains.


 

Tests in bold offered at pft at ALLERGY & ASTHMA


return to top

3.) COPD

Initial Evaluation:

  • Pre & Post-Bronchodilator Spirometry 
  • Lung Volumes: Residual Volume (RV) and Total Lung Capacity (TLC)
  • Diffusing capacity of carbon monoxide (DLCO)

  

For monitoring

  • Spirometry


Consider also:

  • Arterial Blood Gas (ABG) when FEV1 <50% predicted. An algorithm for the prescription of oxygen to COPD patients is discussed in the  2018 Global Strategy for Prevention, Diagnosis and Management of COPD, which can be found at https://goldcopd.org/gold-reports/ see pages 89-90. Or, see page 26 of the 2018 Gold Pocket Guide, found at the same web location.

 

Tests in bold offered at pft at ALLERGY & ASTHMA


return to top

4.) CORONARY ARTERY DISEASE

Consider Pre & Post-Bronchodilator Spirometry which may provide information about comorbid conditions such as COPD, or adverse effects of non-selective beta-adrenergic antagonists (e.g. Propranolol, Carvedilol, Labetalol, Nadolol, Pindolol, Sotalol, Timolol).


 

Tests in bold offered at pft at ALLERGY & ASTHMA


return to top

5.) COUGH (chronic)

Consider:

  • Pre & Post-Bronchodilator Spirometry
  • A reduced DLCO, characteristic of pulmonary parenchymal restrictive disorders may also be consistent with emphysema or pulmonary vascular disorders (e.g. primary pulmonary hypertension, scleroderma, pulmonary emboli, other vasculitides).
  • Methacholine Challenge Test (MCT)
  • Flow-Volume Loop

 

Tests in bold offered at pft at ALLERGY & ASTHMA


return to top

6.) DIFFUSE INTERSTITIAL CHANGES on CXR

Consider:

  • Pre & Post-Bronchodilator Spirometry
  • Determination of DLCO 
  • Pulse oximetry at rest and with exercise
  •  Lung Volumes: Residual Volume (RV) and Total Lung Capacity (TLC) 
  • Lung compliance and recoil

 

Tests in bold offered at pft at ALLERGY & ASTHMA


return to top

7.) DYSPNEA (exertional)

 Consider:

  • Pre & Post-Bronchodilator Spirometry
  • Determination of DLCO 
  • Pulse oximetry at rest and with exercise
  • Lung Volumes: Residual Volume (RV) and Total Lung Capacity (TLC) 
  • Lung compliance and recoil
  • Methacholine Challenge Test (MCT) if PFTs are normal or nearly normal and question about diagnosis remains.

 

Tests in bold offered at pft at ALLERGY & ASTHMA


return to top

8.) NEUROMUSCULAR DISEASE

Consider:

  • Pre & Post-Bronchodilator Spirometry
  • Determination of DLCO 
  • Maximal respiratory pressures

 

Tests in bold offered at pft at ALLERGY & ASTHMA


return to top

9.) OCCUPATIONAL EXPOSURES

 

  • Pre & Post-Bronchodilator Spirometry

 

Tests in bold offered at pft at ALLERGY & ASTHMA


return to top 

10.) RECURRENT BRONCHITIS or PNEUMONIA

Initial Evaluation:

  • Pre & Post-Bronchodilator Spirometry 


Consider also:

  • Methacholine Challenge Test (MCT) if PFTs are normal or nearly normal and question about diagnosis remains.

 

Tests in bold offered at pft at ALLERGY & ASTHMA


return to top

11.) SMOKER

Consider:

  • Pre & Post-Bronchodilator Spirometry

 

Tests in bold offered at pft at ALLERGY & ASTHMA


return to top

12.) SYSTEMIC DISEASES

Consider:

Complete Pulmonary Function Testing

  • Pre & Post-Bronchodilator Spirometry
  • Lung Volumes: Residual Volume (RV) and Total Lung Capacity (TLC)
  • Determination of DLCO

 

Tests in bold offered at pft at ALLERGY & ASTHMA


return to top