ATS Pulmonary Function Laboratory Manual

CHAPTER  12

3.

Suggestion 3.1.

Both bronchoconstriction and bronchodilatation can be induced by suggestion (22–24). Tell patients they will be inhaling a mist that could make them feel worse, feel better, or cause no change (25). Avoid giving them too much information. Informed consent and pre-test questionnaire 4.1. A consent form describing the procedure should be carefully read and signed by the patient or parent/legal guardian of the patient prior to the challenge. 4.2. The consent form should not provide information that will suggest a specific outcome. 4.3. An example consent form is presented in Appendix 12.1. 4.4. A pre-test questionnaire should be administered and may alert the technician to important issues, including contraindications for testing, recent exposures or viral infections, and medications that may alter airway responsiveness (10). See Appendix 12.2 for an example. ASSESSMENT OF PATIENTS 1. The patient’s medical history should be reviewed by a trained physician or professional including current medications, current symptoms, clinical diagnosis, and reason for the test. 2. Assess each patient for physical and developmental status to determine ability to undergo the diagnostic test(s) and if special arrangements are required. If there is a language barrier, an interpreter will be used. 3. Ask each patient if he/she has complied with the preparation criteria, including: 3.1. Withholding the medications that may affect the outcome of the test 3.2. Any recent serious illnesses (e.g., myocardial infarction). 4. Postponement may be necessary if the patient has not complied with the preparation criteria. The ordering physician is to be contacted to determine if rescheduling is necessary. 4.1. In the event the ordering physician cannot be contacted, the laboratory medical director (or designee) should determine if testing should proceed. 5. In order to properly document and interpret the test results, relevant clinical information including the clinical indication for ordering the test must be provided in writing by the ordering physician. EQUIPMENT PREPARATION AND CALIBRATION CHECKS 1. Preparation 1.1. Remove the methacholine solutions from refrigerator and allow them to equilibrate to room temper- ature (approximately 30 minutes) because the temperature of the solution affects nebulizer output. 1.2. Check the nebulizer and compressed gas systems to ensure they are working properly 2. Calibration 2.1. Calibrate the PF testing system each day of use and before the challenge. 4. 5. Instructions 5.1. Before the challenge, the technician will explain and demonstrate the test requirements to the patient including inhalation of the test solutions and performance of pulmonary function (PF) tests.

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