PATIENT INFO
PULMONARY FUNCTION TESTING
Pulmonary function tests (PFT’s) are breathing tests to find out how well you move air in and out of your lungs and how well oxygen enters your body. A complete test can take up to 60 minutes. Please arrive on time for your appointment or you will need to be rescheduled to a different date. The most common PFT’s are spirometry (spy-RAH-me-tree), diffusion studies and body plethysmography (ple-thiz-MA-gra-fee). Sometimes only one test is done, other times all tests will be scheduled, often on the same day.
Lung function tests can be used to:
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Compare your lung function with known values that show how well your lungs should be working.
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Measure the effect of chronic diseases like asthma, chronic obstructive lung disease (COPD), or cystic fibrosis on lung function.
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Identify early changes in lung function that might show a need for a change in treatment.
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Detect narrowing in the airways.
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Decide if a medicine (such as a bronchodilator) could be helpful to use.
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Show whether exposure to substances in your home or workplace have harmed your lungs.
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Determine your ability to tolerate surgery and medical procedures.
(Reference: ATS - see link below)
To get the most accurate results from your breathing tests:
No heavy exercise 1 hour before testing
Avoid wearing tight fitting clothing that makes it hard to breathe deeply
No smoking on the day of your test PRIOR
Avoid large meals 2 hours before testing
(fasting NOT required)
No alcohol 4 hours before testing
If you have a flu/fever/severe headache or diarrhea postpone the test
Unless instructed otherwise, STOP the following medications BEFORE testing:
STOP 4 hours before Ventolin (Salbutamol) and Atrovent (Ipratropium)
STOP 12 hours before All other inhalers (list below)
Symbicort, Advair, Breo, Zenhale
Anoro, Ultibro, Duoklair, Inspiolto Onbrez, Serevent, Foradil
Spiriva, Incruse, Tudorza, Seebri
For further information read the excellent Pulmonary Function Testing guide from the American Thoracic Society at:
https://www.thoracic.org/patients/patient-resources/resources/pulmonary-function-tests.pdf
METHACHOLINE CHALLENGE TESTING
What is a Methacholine Challenge Test?
Your health care provider may have ordered a methacholine challenge test (MCT) to find out if your breathing problem is from asthma. If you have asthma, your provider may order the test to check if your asthma is under control. This test typically takes between 30 to 60 minutes to complete.
Methacholine acts to irritate the airway lining and causes it to tighten in certain patients. This effect is only very short lasting and resolves completely without causing any permanent side effects.
What happens during a Methacholine Challenge Test?
If you have asthma, your airways will tighten when you breathe in methacholine which is detected as a drop in lung function with breathing tests (spirometry). During the MCT, you will inhale a very small dosage of methacholine. Before and after each dose of methacholine, you will be asked to perform the breathing test. If your breathing does not change with the first dosage, you will be asked to inhale progressively larger dosages of methacholine until you have a significant drop in lung function or symptoms. If your airways tighten at any point, you will be given an inhaled bronchodilator medicine to open your airways. Often, the staff person doing the test will know that your airways are tightening before you feel it, by seeing a drop in the breathing test. (Reference: ATS - see link below)
To get the most accurate results from your testing:
No exercise PRIOR to the test
Avoid large meals 2 hours before testing
(may have light meal)
No smoking PRIOR to the test
If you are pregnant or breastfeeding please RESCHEDULE this test
Avoid wearing tight fitting clothing that makes it hard to breathe deeply
If you have a cough/cold/flu please RESCHEDULE this test
**If any further specific instructions or restrictions are required prior to your testing the office will call you to let you know
Before testing the following medications should be stopped:
7 Days Before
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Tudorza (Aclidinium)
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Seebri (Glycopyrronium)
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Inspiolto Respimat, Spiriva (Tiotropium)
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Incruse Ellipta (Umeclidinium)
3 Days Before
(72 Hours)
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Gravol (Dimenhydrinate)
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Anti-Histamines (Reactine, Claritin, Aerius, Benadryl)
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Atarax (Hydroxazine)
2 Days Before
(48 Hours)
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Onbrez Breezhaler (Indacterol)
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Striverdi Respimat (Olodaterol)
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Breo Ellipta (Vilanterol)
1.5 Days Before
(36 Hours)
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Foradil, Oxeze, Symbicort, Zenhale (Formoterol)
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Advair, Serevent (Salmeterol)
12 Hours Before
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Atrovent (Ipratropium)
6 Hours Before
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Airomir, Bricanyl, Ventolin (Salbutamol)
** Please inform the Laboratory if you are taking the following beta-blocker medication to control your high blood pressure.
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Atenol-APO (Atenolol)
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Betaloc (Metoprolol tartrate)
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Brevibloc (Esmolol HCl)
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Lopresor (Metoprolol tartrate)
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Monocor (Bisoprolol fumarate)
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Nadol-APO (Nadolol)
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Propanolol-APO (Propranolol HCl)
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Sectral (Acebutolol HCl)
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Slow-Trasicor (Oxprenolol HCl)
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Timol-APO (Timolol maleate)
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Transdate (Labetalol HCl)
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Visken (Pindolol)
For further information read the excellent Methacholine Challenge Testing guide from the American Thoracic Society at:
https://www.thoracic.org/patients/patient-resources/resources/lung-function-studies-methacholine.pdf
BRONCHOSCOPY
What is Bronchoscopy?
Flexible bronchoscopy (bron-kos’ko-pi) is a visual exam of the breathing passages of the lungs (called “airways”). It is also called airway endoscopy. This test is done when it is important for your doctor to see inside the airways of your lungs, or to get samples of mucus or tissue from the lungs.
Bronchoscopy involves placing a thin tube-like instrument called a bronchoscope (bron’ko-sko¯p) through the nose or mouth and down into the airways of the lungs. The tube acts as a camera and is able to carry pictures back to a video screen. (Reference: ATS - see link below)
Source: ATS (see ref below)
Why is Bronchoscopy required?
There can be a number of reasons to complete a bronchoscopy including:
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Diagnosis of infections in the lungs/airways
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Investigation of lung spots/abnormalities seen on chest x-rays or CT scans
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Diagnosis of autoimmune conditions that can affect the lungs
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Clearing airway blockages or retrieving swallowed airway foreign bodies
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Investigation of possible airway narrowing
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Further investigation of airway bleeding to find a source
What should I expect at my Bronchoscopy?
Depending on the issue being investigated a number of different interventions are possible during the procedure. In brief though, you will go to the Endoscopy department at KGH and check in, change into a hospital gown, meet with the nurse who will place and IV and assess your baseline vital signs. You will then be brought into the procedure room where you will meet the Respirologist performing the procedure. They will review the risks and benefits of the procedure (see section below) and answer any questions that you may have.
Next, using a freezing spray and mouth wash your throat will be anesthetized for your comfort. Once this is done medications will be given by IV to put you into a sleepy state ("conscious sedation"). In this state most people will not remember most of the procedure but will be able to obey instructions given during the procedure.
After the procedure you will be closely monitored while the sedation wears off. This generally takes between 1-2 hours after the end of the procedure. These effects can last longer and as a result you are NOT permitted to drive for the remainder of the day after this procedure. We also ask that you have someone watch you for the remainder of the day while you are at home. If you do not have someone with you to drive you home and watch you for the remainder of the day we will have to CANCEL your procedure, there are no exceptions to this rule. This is required for your own safety.
What are the risks of a Bronchoscopy?
Overall, bronchoscopy is a very safe and common procedure. There is a less than 1-5% risk of major complications in most cases. Below are some of the side effects that you may encounter during or after the procedure:
Coughing / Throat Discomfort
This resolves in the hours following the procedure and occurs in most patients
Reduced Oxygen Levels
Lung "Leak" - Pneumothorax
We will provide additional oxygen during your procedure to prevent this
Usually less than 1% risk, if biopsies are taken this risk can be up to 10%
Usually less than 1% risk, if biopsies are taken this risk can be up to 10%
Lung "Leak" - Pneumothorax
Bleeding
Usually this is minor and resolves over the hours after the procedure without treatment. In some cases more serious bleeding can occur
Infection
In rare cases bacteria from your mouth/nose can pass into the lungs causing infections after the procedure. If this occurs treatment with an antibiotic is all that is required
Fever
Often the evening after the procedure you may have a low-grade fever. This is normal and can be treated with Tylenol. if it persists let your doctor know
** Your Respirologist will go over these risks and how they may be more or less common in your particular case before your procedure to ensure you have a chance to ask any questions.
For further information read the excellent Bronchoscopy guide from the American Thoracic Society at:
https://www.thoracic.org/patients/patient-resources/resources/flexible-bronchoscopy.pdf
Where do I go at Kingston General Hospital (KGH) the day of my procedure?
STEP 1:
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Enter the Main Lobby of KGH and proceed to the "Armstrong Wing" to register at the Admitting office (See map below).
STEP 2:
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Once you have a hospital bracelet from Admitting walk down the long corridor from Armstrong to the Douglas Wing. Turn left before you get to the Lottery Kiosk (follow overhead signs for "Endoscopy"). Sign in at Endoscopy with the receptionist. (See map below).
STEP 3:
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You will receive further instructions from the Endoscopy receptionist about what to do next.
= Endoscopy unit (see map)
= Admitting Office
For parking information refer to the KGH Website
http://www.kgh.on.ca/patients-families-and-visitors/getting-kgh/parking-kgh
PLEURX CATHETER
What is a PleurX Catheter?
PleurX is a semi-permanent chest tube that is tunneled under the skin surface and into the pleural space (the space around the lungs) to drain fluid from recurring pleural fluid. The tube is made of a soft, flexible silicone material and is covered on the skin surface with a padded bandage. There is a cuff on the PleurX that will grow into your skin and secure the tube in place.
Infection
5% risk (1:20) but >50% of these infections will resolve with antibiotics alone and the tube can remain in place
Lung "Leak" - Pneumothorax or Organ Injury
~1-2% risk with ultrasound use which allows us to carefully choose the insertion site.
Pain at insertion site
We use an injection of lidocaine to freeze the site before the procedure. The insertion site will be sore/bruised for a few days. Pain control medications can be provided to help with this.
Short Term Chest Discomfort or Cough
After fluid is removed some patients will experience mild chest pain as their lung re-expands. This usually resolves after a few minutes to hours.
Bleeding
This is generally very minor and only causes some bruising at the insertion site. In rare cases more serious bleeding can occur (<0.2% risk)
Loculations or Trapped Lung
In some cases all the fluid does not drain and some fluid can become trapped which prevents complete expansion of the lung
THORACENTESIS
What is a Thoracentesis?
Thoracentesis (thor-a-sen-tee-sis) is a procedure that is done to remove a sample of fluid from around the lung. The lung is covered with a tissue called the pleura. The inside of the chest is also lined with pleura. The space between these two areas is called the pleural space. This space normally contains just a thin layer of fluid, however, some conditions such as pneumonia, some types of cancer, or congestive heart failure may cause excessive fluid to develop (pleural effusion).
To remove this fluid for evaluation (testing) or to reduce the amount of fluid, a procedure called a thoracentesis is done. Thoracentesis involves placing a thin needle or tube into the pleural space to remove some of the fluid. The needle or tube is inserted through the skin, between the ribs and into the chest. This procedure may be done to remove fluid for testing or for treatment. The needle or tube is removed when the procedure is completed. If a person needs more fluid drained, sometimes the tube is left in place for a longer time. (Reference: ATS - see link below)
THORACENTESIS
Pleural Effusion
Collapsed Lung
Why do I need a Thoracentesis?
There are a number of reasons to perform this procedure. Any condition that results in the accumulation of fluid outside of the lung (between the chest wall and the lungs - in the space called the pleural space) can benefit from this intervention. Some specific reasons include:
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Suspected infections - To determine if bacteria or fungi are present in the fluid to allow for planning of further treatment
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Diagnosis of cancers - Many cancers will result in a pleural effusion. The fluid removed can be examined under a microscope and in some cases if cancer cells are seen can give a diagnosis for the type of cancer saving you the need for more invasive procedures to biopsy at other sites
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Therapeutic comfort - Some conditions like heart, lung, liver and other diseases cause fluid to accumulate at regular intervals. As fluid builds up it can cause progressive shortness of breath which can affect quality of life. Regular drainage can help to reverse these symptoms. See above section of Pleurx catheters which can be a more permanent solution.
What are the risks of a Thoracentesis?
This is a very common procedure for a Respirologist to perform. The risks are generally minimal and easily managed. Especially with the use of ultrasound before the procedure which gives a very clear view of the fluids location. Risks include:
Infection
The procedure is done using sterile technique to minimize this risk.
Lung "Leak" - Pneumothorax
~2% risk with ultrasound use. In some rare cases a chest tube may required to drain the leaking air
Pain at insertion site
We use an injection of lidocaine to freeze the site before the procedure. Lidocaine causes momentary stinging.
Short Term Chest Discomfort
After fluid is removed some patients will experience mild chest pain as their lung re-expands.
Bleeding
This is generally very minor and only causes some bruising at the insertion site. In rare cases more serious bleeding can occur (<0.2% risk)
Coughing
This resolves in a few minutes to a few hours following the procedure and occurs in most patients. It is normal
** Your Respirologist will go over these risks and how they may be more or less common in your particular case before your procedure to ensure you have a chance to ask any questions.
For further information read the excellent Thoracentesis guide from the American Thoracic Society at:
https://www.thoracic.org/patients/patient-resources/resources/thoracentesis.pdf
Page References:
Pulmonary Function Testing Section -
Marianna Sockrider, MD, DrPH et al, Pulmonary Function Tests - ATS Patient Information Series, Am J Respir Crit Care Med Vol. 189, P17-P18, 2014
Methacholine Challenge Testing Section -
Marianna Sockrider, MD, Lung Function Studies: Methacholine Challenge Testing - ATS Patient Information Series, Am J Respir Crit Care Med Vol. 180, P3-P4, 2009
Bronchoscopy Section -
Manthous, C et al, Bronchoscopy - ATS Patient Information Series, Am J Respir Crit Care Med Vol. 191, P7-P8, 2015
Pleurx Section -
Thoracentesis Section -
MM Sockrider MD et al, Thoracentesis - ATS Patient Information Series, Am J Respir Crit Care Med Vol. 176, P1-P2, 2007