ATS Pulmonary Function Laboratory Manual

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

5. Appropriate standard precautions (SP) attire and gloves for the technician (45) 6. Resuscitation cart (6, 37, 46) 6.1. Airway-management equipment 6.2. Defibrillator 6.3. Suction 6.4. Emergency medications (e.g. epinephrine and lidocaine) 6.5. Bronchodilators (6) 6.6. Oxygen (O 2 ) equipment and delivery systems (6) 7. Pulse oximeter with a variety of appropriate probes (e.g. ear, finger, reflectance) 8. Chart displaying the ratings of perceived exertion (RPE) scale also known as the Borg scale (47) 9. Inhalant 9.1. Because the tendency to elicit airway narrowing is enhanced when the inhalant is cool and/or dry, special attention to the inhalant is needed. 9.2. If possible, the absolute water content of the inspired air should be below 10 mg/L or relative humidity (RH) less than 50% between 20 and 25° C (6, 36, 48). 9.3. Inhaled gases other than room air can be used but are not required. 9.4. If not using room air, a dry gas source (e.g., compressed air cylinder) with reservoir bag, valves and tubing, or demand valve (48). 9.5. Cold air can be added using a cold-air generating device when the patient’s complaints specifically relate to symptoms induced by cold air inhalation; however, cold air is generally not necessary to elicit bronchoconstriction (18, 48). Patient Preparation (Pre-test instructions) 1. The patient should be instructed to wear loose-fitting, comfortable clothing and shoes suitable for exercise. 2. The patient should abstain from eating a heavy meal, smoking cigarettes, and consuming alcohol 3 hours prior to test (43, 46, 49–51). 3. The patient should refrain from heavy exercise for at least 4 hours, as this has been found to exert a protective effect (52). 4. The patient should refrain from taking medications that can influence their airway responsiveness to exer- cise (6, 48–51, 53–55). The medications and the time period for withholding them prior to the test are listed in Table 14.3. 5. There should be a brief explanation of the procedure and the patient’s questions should be answered before the test (36, 46, 51). 6. Informed consent should be obtained and witnessed by personnel who can accurately describe the test and potential risks (37, 38, 49, 56) ( see Appendix 14.1). 7. Other variables that could affect the diagnostic value of the procedure include: 7.1. Regular use of bronchodilators increases the severity of EIB (57, 58). 7.2. A recent study demonstrated a preventative effect of a single high dose of an inhaled corticosteroid prior to exercise and eucapnic hyperventilation challenge (59, 60).

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