ATS Pulmonary Function Laboratory Manual

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

Table 13.2

Relative Contraindications for Mannitol Challenge Test (7)

Relative contraindications for testing include: • The test should not be performed on those with known hypersensitivity to mannitol or to the gelatin used to make the capsules

• Inability to perform acceptable-quality spirometry • Moderate or more severe airflow limitation (i.e., FEV 1

< 70% predicted)

• A ≥10% reduction in FEV 1 after administration of the 0-mg capsule • The test should not be performed on those with conditions such as: severe cough, ventilatory impairment, spirometry-induced bronchoconstriction, hemoptysis of unknown origin, pneumothorax, recent abdominal, thoracic or eye surgery, unstable angina, or active upper or lower respiratory tract infection. • History of cardiovascular problems • Pregnancy or nursing mothers from pre-challenge FEV 1

Equipment and Supplies 1. Bronchial challenge test kit (mannitol capsules, inhaler, instructions) 2. Spirometer, mouthpiece, and nose clip 3. Timer and calculator 4. Short-acting bronchodilator (e.g., albuterol) 5. Medication and emergency equipment in testing area

Patient Preparation (Pre-test instructions) 1. The patient should refrain from taking medications that can influence their airway responsiveness to the mannitol challenge test. The medications and time period for withholding them prior to the test are listed in Table 13.3. Assessment of Patients 1. The patient’s medical history should be reviewed by a trained physician or professional. This should include: 1.1. Current medications (e.g., bronchodilator and medications for control of blood pressure) 1.2. Other test results including pulmonary function tests, blood gas data, chest radiograph, and blood chemistry 1.3. Current symptoms, including chest pain, discomfort or wheezing, shortness of breath, and dyspnea on exertion 1.4. The clinical diagnosis and reason for the test. 2. Assess each patient for physical and development status to determine ability to perform the diagnostic procedure and if special arrangements are required. If there is a language barrier, an interpreter will be used. 3. Ask each patient if they have complied with the preparation procedures, including: 3.1. If they have eaten recently and, if so, when. 3.2. If they have taken any medications for their breathing.

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