ATS Pulmonary Function Laboratory Manual

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

Effective Date: 2014 Version #1

Chapter 7

procedure name: bronchodilator administration

Purpose Assessment of airflow-limitation reversibility with drug administration is commonly done as part of pulmonary function (PF) testing. The purpose of this test is to determine whether a patient’s lung function can be improved. PF tests (e.g., spirometry) are done before and after (pre-/post-) drug (bronchodilator) administration and the response measured. Many variables affect the bronchodilator response (1). Some patients may respond to one type of bronchodilator but not to another, or they may have a variable response to the same medication at different times. Several factors must be considered in order to standardize assessment of bronchodilator response. These factors are primarily related to the methods used by the laboratory. Beta-adrenergic aerosols are the most commonly used form of bronchodilator for pre- and post-testing, although the evaluation of other drugs can be conducted as requested by referring physicians. The drug, its dosage, and the means of delivery should be standardized as much as possible. Evaluating response to bronchodilators requires withholding the usual dose of bronchodilator before testing (2). Recommended times for withholding bronchodilators when the PF test bronchodilator response is to be assessed are presented in Table 7.1. Table 7.1 Recommended Time Periods for Withholding bronchodilators before Bronchodilator-Response Testing Bronchodilator Medication Length of Abstention

Short-acting beta agonists (e.g., albuterol, salbutamol) Iprtatriopium (Atrovent) Long-acting beta agonists (e.g., formoterol, salmeterol)

4–6 hours

6 hours 12 hours

Ultra–long-acting agents (e.g.,tiotropium, indacaterol, vilanterol)

24 hours

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