Aerosol Use in the Pulmonary Function Lab

G. L. Ruppel
2015 Respiratory care  
Aerosols in the Pulmonary Function Testing Lab How Aerosols Are Administered in the PFT Lab Bronchodilators Bronchial Challenge Agents Bronchodilator Testing Inhaled Bronchial Challenge Agents Safety During Bronchoprovocation Summary Aerosolized medications are frequently used in the pulmonary function laboratory. The 2 most common implementations are bronchodilators and bronchial challenge agents. Bronchodilator administration is not well standardized, largely because of the various methods of
more » ... delivery available for clinical practice. Metered-dose inhalers used with spacer devices are the most common route for bronchodilator administration, but many laboratories use small-volume nebulizers. Interpretation of pre-and post-bronchodilator studies is confounded by the definitions of airway obstruction and bronchodilator responsiveness. Protocols for administering bronchial challenge aerosols (methacholine, mannitol, hypertonic saline) are well defined but are susceptible to some of the same problems that limit comparison of bronchodilator techniques. Bronchial challenges with inhaled aerosols are influenced not only by the delivery device but by the patient's breathing pattern, particularly in protocols that include deep inspiratory efforts. Care 2015;60(6):931-940. © 2015 Daedalus Enterprises] Aerosols in the Pulmonary Function Testing Lab Aerosolized agents are an essential component of pulmonary function testing (PFT). 1 Inhaled bronchodilators are widely used to assess reversibility of airway obstruction, particularly in patients suspected of having asthma. 2 Measure-ment of the FEV 1 /FVC ratio after administration of a ␤ agonist is the de facto test to establish the diagnosis of COPD. 3 Similarly, measurement of FEV 1 following bronchodilator administration is used to categorize the severity of airway obstruction. Improvement in air flow is the primary end point in the evaluation of new inhaled bronchodilators, and PFT provides the necessary tools for assessment. The other primary use of aerosols in the PFT lab involves inhaled bronchial challenge agents. As is the case for bronchodilators, bronchial provocation using an aerosolized agent is a key tool for making or excluding the diagnosis of asthma. 4 Inhalation of challenge aerosols also provides a means to quantify the degree of hyper-responsiveness. How Aerosols Are Administered in the PFT Lab Bronchodilators Bronchodilators can be administered by various methods for diagnostic purposes. Typically, a ␤ agonist or an-Mr Ruppel is affiliated with the Division
doi:10.4187/respcare.03493 pmid:26070584 fatcat:qcjccdqcijechhfx2uap2d6wtm