ATS Pulmonary Function Laboratory Manual

cHAPTER 7

(Continued from previous page)

Bronchodilator Administration

Step Action

Place the appropriate amount of drug in nebulizer. Adjust airflow as recommended by nebulizer manufacturer. Have the patient take slow, moderately deep breaths (i.e., ∼ 1 L/s for adults) with mouthpiece (preferred) or mask in place. If a thumb-valve is used, the open port should be occluded upon inspiration and then reopened upon exhalation. Continue until prescribed dose is completely nebulized.

3. Obtain physiologic data (e.g., pulse rate, blood pressure) approximately 5 minutes after bronchodila- tor has been administered, or earlier if patient complains of symptoms (palpitations, light-headedness, flushing). 4. Premature discontinuation of bronchodilator administration. If patient complains of symptoms (palpi- tations, light-headedness, flushing), discontinuation of bronchodilator may be necessary. In the event of serious arrhythmia, tachycardia >120 beats/min, or marked elevation in blood pressure, stabilize the patient and notify the ordering physician or medical director.

Post-Bronchodilator Administration

Step Action 1.

Wait at least 10 minutes after bronchodilator administration and then repeat spirometry and/or plethysmography (2). 2. If the bronchodilator is administered after a bronchial challenge, a return to at least 90% of the baseline value should be observed. If the response is less than this, a repeat administration of the bronchodila- tor may be indicated. Reporting Results 1. The percent change after bronchodilator administration is calculated as follows: post-bronchodilator value − pre-bronchodilator value % change = ____________________________________________ × 100 pre-bronchodilator value Pre-bronchodilator values and post-bronchodilator values are any PF variables (e.g., FEV 1 ). Note that increased flows or volumes will result in a positive number, while decreased flows or volumes result in a negative number. 2. An alternative method (11) of calculating bronchodilator response is: post-bronchodilator value − pre-bronchodilator value % change = ____________________________________________ × 100 predicted value

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