Pulmonary function tests

Pulmonary function tests are a group of tests that measure how well the lungs take
in and release air and how well they move gases such as oxygen from the
atmosphere into the body's circulation.

How the Test is Performed

In a spirometry test, you breathe into a mouthpiece that is connected to an
instrument called a spirometer. The spirometer records the amount and the rate of
air that you breathe in and out over a period of time.
For some of the test measurements, you can breathe normally and quietly. Other
tests require forced inhalation or exhalation after a deep breath.
Lung volume measurement can be done in two ways:

• The most accurate way is to sit in a sealed, clear box that looks like a
telephone booth (body plethysmograph) while breathing in and out into a
mouthpiece. Changes in pressure inside the box help determine the lung
volume.
• Lung volume can also be measured when you breathe nitrogen or helium gas
through a tube for a certain period of time. The concentration of the gas in a
chamber attached to the tube is measured to estimate the lung volume.

To measure diffusion capacity, you breathe a harmless gas for a very short time,
often one breath. The concentration of the gas in the air you breathe out is
measured. The difference in the amount of gas inhaled and exhaled measures how
effectively gas travels from the lungs into the blood.

How to Prepare for the Test

Do not eat a heavy meal before the test. Do not smoke for 4 - 6 hours before the
test. You'll get specific instructions if you need to stop using bronchodilators or
inhaler medications. You may have to breathe in medication before the test.

How the Test Will Feel

Since the test involves some forced breathing and rapid breathing, you may have
some temporary shortness of breath or lightheadedness. You breathe through a
tight-fitting mouthpiece, and you'll have nose clips.

Why the Test is Performed

Pulmonary function tests are done to:

• Diagnose certain types of lung disease (especially asthma, bronchitis, and

emphysema)
• Find the cause of shortness of breath
• Measure whether exposure to contaminants at work affects lung function
It also can be done to:

• Assess the effect of medication

• Measure progress in disease treatment

Spirometry measures airflow. By measuring how much air you exhale, and how
quickly, spirometry can evaluate a broad range of lung diseases.
Lung volume measures the amount of air in the lungs without forcibly blowing out.
Some lung diseases (such as emphysema and chronic bronchitis) can make the
lungs contain too much air. Other lung diseases (such as fibrosis of the lungs
and asbestosis) make the lungs scarred and smaller so that they contain too little
air.
Testing the diffusion capacity (also called the DLCO) allows the doctor to estimate
how well the lungs move oxygen from the air into the bloodstream.

Arterial Blood Gas

Blood gases is a measurement of how much oxygen and carbon dioxide is in your
blood. It also determines the acidity (pH) of your blood.

How the Test is Performed

Usually, blood is taken from an artery. The blood may be collected from the radial
artery in the wrist, the femoral artery in the groin, or the brachial artery in the arm.
The health care provider may test circulation to the hand before taking a sample of
blood from the wrist area.
The health care provider will insert a small needle through the skin into the artery.
You can choose to have numbing medicine (anesthesia) applied to the site before
the test begins.
In rare cases, blood from a vein may be used.
After the blood is taken, pressure is applied to the site for a few minutes to stop the
bleeding. The health care provider will watch the site for signs of bleeding or
circulation problems.
The sample must be quickly sent to a laboratory for analysis to ensure accurate
results.

How to Prepare for the Test

There is no special preparation. If you are on oxygen therapy, the oxygen
concentration must remain constant for 20 minutes before the test.

How the Test Will Feel

You may feel brief cramping or throbbing at the puncture site.

Why the Test is Performed

The test is used to evaluate respiratory diseases and conditions that affect the
lungs. It helps determine the effectiveness of oxygen therapy. The test also
provides information about the body's acid/base balance, which can reveal
important clues about lung and kidney function and the body's general metabolic
state.

• Acidosis
• Diabetic ketoacidosis
• Lactic acidosis
• Metabolic acidosis
• Respiratory acidosis
• Respiratory alkalosis

Throat swab culture

A throat swab culture is a laboratory test done to isolate and identify organisms that
may cause infection in the throat.

How the Test is Performed

You will be asked to tilt your head back and open your mouth wide. The health care
provider rubs a sterile cotton swab along the back of your throat near the tonsils.
You need to resist gagging and closing the mouth while the swab touches this area.
The health care provider may need to scrape the back of the throat with the swab
several times. This helps improve the chances of detecting bacteria.
How to Prepare for the Test
Do not use antiseptic mouthwashes before the test.

How the Test Will Feel

Your throat may be sore at the time the test is taken. You may experience a
gagging sensation when the back of your throat is touched with the swab, but the
test only lasts a few seconds.

Why the Test is Performed

The test is performed when a throat infection is suspected, particularly strep throat.
A throat culture can also help your doctor determine which antibiotics will work best
for you.

Chest x-ray
A chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and
diaphragm.

How the Test is Performed

The test is performed in a hospital radiology department or in the health care
provider's office by an x-ray technician. Two views are usually taken: one in which
the x-rays pass through the chest from the back (posterior-anterior view), and one
in which the x-rays pass through the chest from one side to the other (lateralview).
You stand in front of the machine and must hold your breath when the x-ray is
taken.

How to Prepare for the Test

Inform the health care provider if you are pregnant. Chest x-rays are generally
avoided during the first six months of pregnancy. You must wear a hospital gown
and remove all jewelry.

How the Test Will Feel

There is no discomfort. The film plate may feel cold.

Why the Test is Performed

Your doctor may order a chest x-ray if you have any of the following symptoms:

• A persistent cough
• Chest injury
• Chest pain
• Coughing up blood
• Difficulty breathing

It may also be done if you have signs of tuberculosis, lung cancer, or other chest
or lung disease.
A serial chest x-ray (repeated) may be used to evaluate or monitor changes found
on a previous chest x-ray.

What Abnormal Results Mean

In the lungs:

• Collapsed lung
• Collection of fluid around the lung
• Lung cancer
• Lung tumor
• Malformation of the blood vessels
• Pneumonia
• Scarring of lung tissue
• Tuberculosis
Chest CT Scan

What Is a Chest CT Scan?

A chest computed tomography (to-MOG-ra-fee), or CT, scan is a painless,

noninvasive test. It creates precise images of the structures in your chest, such as
your lungs. “Noninvasive” means that no surgery is done and no instruments are
inserted into your body.

A chest CT scan is a type of x ray. However, a CT scan’s pictures show more details
than pictures from a standard chest x ray.

Like other x-ray tests, chest CT scans use a form of energy called ionizing radiation.
This energy helps create pictures of the inside of your chest.

Overview

Doctors use chest CT scans to:

• Show the size, shape, and position of your lungs and other structures in your
chest.
• Follow up on abnormalities that are found on standard chest x rays.
• Find the cause of lung symptoms, such as shortness of breath or chest pain.
• See whether you have a lung problem, such as a tumor, excess fluid around
the lungs, or a pulmonary embolism (PULL-mun-ary EM-bo-lizm; a blood clot
in the lungs). The test also is used to check for other conditions, such as
tuberculosis (tu-ber-kyu-LO-sis), emphysema (em-fi-SE-ma), and pneumonia.

The chest CT scanning machine takes many pictures, called slices, of the lungs and
the inside of the chest. A computer processes these pictures; they can be viewed on
a monitor or printed on film. The computer also can stack the pictures to create a
very detailed, three-dimensional (3D) model of organs.

Sometimes, a special substance (called contrast dye) is injected into a vein in your
arm. This substance highlights areas in your chest, which helps create clearer
images.

How to Prepare for the Test

The health care provider may advise you to avoid eating or drinking for 4 - 6 hours
prior to the scan, if contrast dye is to be used. You may need to have your kidney
function checked with a blood test (creatinine level) prior to the scan.
The CT scanner has a weight limit to prevent damage to the mechanized gantry.
Have the health care provider contact the scanner operator if you weigh more than
300 pounds.
Metal interferes with the x-rays, so you may be asked to remove jewelry and wear a
hospital gown during the study.

How the Test Will Feel

The x-rays are painless. The primary discomfort may be from the need to lie still on
the table.
If intravenous contrast dye is given, you may feel a slight burning sensation in the
injected arm, a metallic taste in the mouth, and a warm flushing of the body. These
sensations are normal and usually go away within a few seconds.

Why the Test is Performed

Thoracic CT may be recommended when there is a need for examination of the
structures inside the chest. It isnoninvasive and poses less risk
than invasive procedures (such as angiography or exploratory surgery).

Common reasons for having a thoracic CT include:

• When there is a chest injury

• When a tumor or mass (clump of cells) is suspected
• To determine the size, shape, and position of internal organs
• To look for bleeding or fluid collections in the lungs or other areas

What Abnormal Results Mean

Thoracic CT may show many disorders of the heart, lungs, or chest area

Pulse Oximetry

(Oxygen Saturation, Oximetry, Ear Oximetry, Pulse Ox, Sp02)

Procedure Overview

What is pulse oximetry?

Pulse oximetry is a procedure used to measure the oxygen level (or oxygen
saturation) in the blood. It is considered to be a noninvasive, painless, general
indicator of oxygen delivery to the tissues (e.g., finger, earlobe, or nose).

How does pulse oximetry work?

Oxygen in the air is breathed into the lungs. The oxygen then passes into the blood
where the majority of the oxygen attaches to hemoglobin (a protein located inside
the red blood cell) for transport in the bloodstream. The oxygenated blood
circulates to the tissues.

Pulse oximetry technology utilizes the light absorptive characteristics of hemoglobin

and the pulsating nature of blood flow in the arteries to aid in determining the
oxygenation status in the body. First, there is a color difference between arterial
hemoglobin saturated with oxygen, which is bright red, and venous hemoglobin
without oxygen, which is darker.

Second, with each pulse or heartbeat there is a slight increase in the volume of
blood flowing through the arteries. Because of the increase of blood volume, albeit
small, there is an associated increase in oxygen-rich hemoglobin. This represents
the maximum amount of oxygen-rich hemoglobin pulsating through the blood
vessels.

A clip-like device called a probe is placed on a body part, such as a finger or ear
lobe, to measure the blood that is still carrying or is saturated with oxygen. The
probe houses a light source, a light detector, and a microprocessor, which compares
and calculates the differences in the oxygen-rich versus oxygen-poor hemoglobin.
One side of the probe has a light source with two different types of light, infrared
and red, which are transmitted through the finger to the light detector side of the
probe. The oxygen-rich hemoglobin absorbs more of the infrared light and the
hemoglobin without oxygen absorbs more of the red light. The microprocessor
calculates the differences and converts the information to a digital readout. This
information helps the physician assess the amount of oxygen being carried in the
blood and evaluate the need for supplemental oxygen.

Reasons for the Procedure

Pulse oximetry may be performed to assess the adequacy of oxygen levels (or
oxygen saturation) in the blood in a variety of circumstances such as surgery, other
procedures involving sedation (e.g., bronchoscopy), adjustment of supplemental
oxygen as needed, effectiveness of lung medications, and patient tolerance to
increased activity levels. Other reasons may include, but are not limited to, the
following:

• mechanical ventilation - use of a ventilator to support breathing

• sleep apnea - periods of cessation of breathing during sleep
• medical conditions, such as heart attack, congestive heart failure, anemia,
lung cancer, asthma, or pneumonia

There may be other reasons for your physician to recommend pulse oximetry.
Before the Procedure

• Your physician will explain the procedure to you and offer you the opportunity
to ask any questions that you might have about the procedure.
• Generally, fasting is not required before the test.
• If a finger probe is to be used, you may be asked to remove fingernail polish.
• Based upon your medical condition, your physician may request other
specific preparation.

During the Procedure

Pulse oximetry may be performed on an outpatient basis or as part of your stay in a

hospital. Procedures may vary depending on your condition and your physician’s
practices.

Generally, pulse oximetry follows this process:

1. A clip-like device called a probe (functions like a clothespin but does not
pinch) will be placed on your finger or earlobe. Alternatively, an adhesive
probe may be placed on your forehead or finger.
2. The probe may be left on for continuous monitoring or only to obtain a
reading.
3. Unless you are to have continuous monitoring, the probe will be removed
after the test.

After the Procedure

You may resume your usual diet and activities unless your physician advises you
differently.

Generally, there is no special care following pulse oximetry. However, your

physician may give you additional or alternate instructions after the procedure,
depending on your particular situation.

Sputum Studies

A sputum sample is obtained by coughing deeply and expelling the material that
comes from the lungs into a sterile cup. The sample is taken to a labarotory and
placed in a medium under conditions that allow the organisms to grow. A positive
culture may identify disease-producing organisms that may help diagnose
bronchitis, tuberculosis, a lung abscess, or pneumonia.