ATS Pulmonary Function Laboratory Manual

ATS Pulmonary Function Laboratory Management & Procedure Manual | 3rd Edition

4.1.3. The use of disposable nebulizers that are discarded after use is recommended. The re-use of disposable nebulizers may give rise to cross contamination. The manufacturers of good-quality nebulizers can provide output specifications, and based on particle size and the ratio of inspira- tory time to total breathing time (Ti/Ttot), the dose can be calculated. 4.3. Compressed gas source, flow meter, and tubing 4.4. Pulmonary function testing system (e.g. spirometers) 4.5. Timer 4.6. Bronchodilator (e.g., inhaled albuterol) for reversal, and oxygen source 4.7. Mouthpiece for nebulizer 4.8. Stethoscope, sphygmomanometer, and pulse oximeter are optional. Patients should be instructed not to take drugs that affect airway caliber and/or are considered antagonists to methacholine for an interval that exceeds their duration of action. These medications and the time period for withholding them prior to the test are presented in Table 12.5. 1.2. Beta-adrenergic blocking agents: The Provocholine ® package insert states methacholine inhalation challenge should not be performed in patients receiving any beta-adrenergic blocking agent because in such patients responses to methacholine chloride can be exaggerated or prolonged, and may not respond as readily to accepted modalities of treatment. Withholding of beta-adrenergic blocking agents or performing the challenge in patients taking such agents should be performed with caution and only upon specific orders from the ordering physician. 2. Caffeine and caffeine-related products have been shown to have no effect of clinical significance (21). Table 12.5 Medication Withholding Recommendations for Methacholine Challenge Test. Medication Length of Abstention Short-acting inhaled beta agonists in conventional doses (e.g., albuterol 200 μg) 6 hours Long-acting inhaled beta agonists (e.g., salmeterol) 36 hours Ultra–long-acting beta agonists (e.g., indacterol, vilanterol) 48 hours Short-acting anticholinergics (e.g., Atrovent 40 μg) 12 hours Long-acting anticholinergics (e.g., Tiotropium) At least 168 hours Oral theophylline 12–24 hours Cromones Do not need to be withheld Leukotriene modifiers Do not need to be withheld (20) Corticosteroids (inhaled, oral) Not usually withheld Antihistamines Not usually withheld for methacholine challenge PATIENT PREPARATION (PRE-TEST INSTRUCTIONS) 1. Medications 1.1.

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