Tests and Treatments

Pulmonary Function Tests

Pulmonary function tests measure how well your lungs work. These tests measure airflow through the lungs, how much air the lungs can take in and how quickly oxygen gets into the blood. Test results can diagnose and measure lung disorders, help determine what treatment is appropriate and how well that treatment is working.

These tests include:

Spirometry

This is the most common lung test. For this test you breathe into the mouthpiece of a machine called a spirometer. This measures airflow – how much air you breathe in and out, and how quickly and deeply you can do it. The results can help diagnose asthma, chronic obstructive pulmonary disease (COPD) and other breathing disorders.

What You Can Expect:

  • You will be seated during the test
  • A clip will be placed on your nose
  • You will breathe in and out into the mouthpiece several times
  • The whole process typically takes less than 15 minutes.

How to Prepare:

  • Talk to your doctor about what medications you are taking, and which you may need to stop before the test.
  • A few hours before the test, avoid:
  • Alcohol
  • Heavy meals
  • Smoking
  • Strenuous exercise
  • Wear loose, comfortable clothing

What Happens After the Test:

If your results are not normal, your doctor may give you medication to open your lungs so that another test may be done. You will need to wait 15 minutes before retaking the test. Comparing the second test to the first can tell your doctor whether your condition can be improved with medication.

Plethysmography

This test measures lung capacity – how much air your lungs can hold.

What You Can Expect:

  • You will either sit or stand in an airtight booth
  • You may be given medication beforehand
  • You will have a clip on your nose
  • You will breathe into a mouthpiece
  • The test usually takes just a few minutes

This is a non-invasive test, however

  • You may feel light headed from breathing heavily. Don’t worry – the medical professional doing your test will keep their eye on you to make sure you are safe.
  • If you are bothered by small spaces, you may be anxious. Though the booth is small, it is also clear, so you can see outside of it at all times.

How to Prepare:

  • Talk to your doctor about what medications you are taking, and which you may need to stop before the test.
  • Six hours before the test avoid:
  • Smoking
  • Heavy meals
  • Strenuous exercise
  • Wear loose, comfortable clothing

Methacholine Challenge Test

This test is used to find out if you have asthma. The test also measures how severe your asthma is. Methacholine is a medication that you inhale through a special breathing device called a nebulizer. This medication causes lung constriction in people with asthma.

What You Can Expect:

  • Before the test begins, your breathing will be measured
  • You will inhale a mist of methacholine through the nebulizer’s mouthpiece
  • After inhaling, you will blow into a spirometer, which measures air flow
  • If you have asthma, the methacholine will cause a lung constriction or spasm
  • At the end of the test, you may be given another medication to stop the effects of the methacholine
  • Your breathing will be measured again before you leave to make sure you are breathing normally
  • The test takes 1-2 hours

During the test you may experience

  • Shortness of breath, wheezing or coughing
  • Headache or dizziness
  • Chest soreness

How to Prepare:

  • Talk to your doctor about what medications you are taking, and which you may need to stop before the test.
  • Tell your doctor if you
  • Have a history of swelling of the upper airway
  • Have a history of hives
  • Are breastfeeding or pregnant
  • Have a heart condition
  • Develop a cold, lung infection or flu before the test
  • Before the test avoid:
  • Smoking for at least 8 hours
  • Heavy meals for 2-3 hours
  • Caffeine for at least 6 hours
  • Lipstick, perfume or cologne the day of the test
  • Strenuous exercise for at least 2 hours
  • Wear loose, comfortable clothing

What Happens After the Test:

  • You may need to use a bronchodilator, medication that relieves any coughing or wheezing after the test.
  • Unless otherwise instructed by your doctor, you can return to your medications, eating patterns, exercise and other activities.
  • Additional tests may take place or be repeated.

Exercise Testing

Exercise tests evaluate the lungs and heart during periods of greater demand and measure blood pressure, breathing, heart rate, carbon dioxide and oxygen levels and physical condition. Two of the most common forms of these tests are the walk test and the cardiopulmonary exercise test (CPET).

The walk test measures how far a person walks for six minutes.

The cardiopulmonary exercise test (CPET) is a computerized breath test to tell how well your heart and lungs work together to deliver oxygen and if there is a problem with one or the other, or both.

What You Can Expect:

During a CPET

  • You will exercise either on a bicycle or treadmill
  • You will be wearing a facemask and blood pressure cuff
  • The intensity of the workout will increase gradually

You may experience:

  • Shortness of breath
  • Chest pains
  • Fatigue

How to Prepare:

  • Before the test avoid:
  • Heavy meals for 2-3 hours
  • Strenuous exercise for 2 hours
  • Wear comfortable clothing

Altitude Testing

The high altitude simulation test (HAST) measures how much oxygen you need at sea level (5,000 feet) compared to an airplane flight or high elevations (8,000 feet). If you have a lung disease, this test makes it safer for you to travel to high altitudes by letting you know if you need to bring extra oxygen with you and how much.

What You Can Expect:

  • You will be seated
  • Your blood pressure and heart rate will be measured
  • You will wear a mask, which is connected to a tank
  • You will be breathe a mixture that is similar to the amount of oxygen you would naturally get at high altitudes
  • You and your vital signs will be watched to keep you safe
  • The test lasts 1-2 hours
  • Your blood pressure and heart rate are checked at the end to make sure you are back to normal
  • No preparation is needed
  • The mask may be a little uncomfortable


Interventional Pulmonology

Interventional pulmonology uses minimally invasive techniques to diagnose and clear airways, treat lung cancer and treat other lung conditions. Minimally invasive techniques are typically less risky and require less recovery time.

These techniques include:

Flexible Bronchoscopy

A flexible bronchoscopy is a minimally invasive way to look at airways for obstructions, take tissue samples, diagnose and treat lung problems. It uses a flexible bronchoscope, which has a small camera that allows your doctor to see inside your lungs.

What You Can Expect:

  • The tube of the flexible scope is less than a half an inch wide and two feet long
  • It is inserted through your mouth or nose and into your lungs
  • You will probably be given medication to help you relax, and you may sleep through the procedure
  • Your oxygen levels will be monitored at all times
  • An anesthetic will be used to numb your mouth or nose and throat
  • You may feel like you have to cough after the tube has been inserted, but that will go away
  • You should not feel pain during this procedure
  • A saline solution may be used to wash the lungs and allow the doctor to collect samples of the lung tissue

How to Prepare:

  • You may need to take a test before the procedure to make sure you have no problems with blood clotting
  • Talk to your doctor about
  • Any heart problems you have
  • What medications you are taking, and which you may need to stoop before the procedure
  • Whether you need to stop smoking for a time beforehand
  • You will probably not be allowed to eat for 8-12 hours beforehand
  • If you have dentures or a retainer, you will need to remove them
  • You will need someone to take you to and from the hospital, because the medication you are given will make it unsafe for you to drive

What Happens After the Test?

  • You will not be able to eat or drink until you have a normal gag reflex, which takes 1-2 hours
  • After a bronchoscopy there may be some bleeding, but it is usually minor
  • If you have had a biopsy during the bronchoscopy, you may also have a chest x-ray afterwards
  • You will probably need to rest the following day and may experience muscle soreness
  • You may run a fever, but it should last no more than a day
  • Your throat may be hoarse for a few days
  • Call your doctor if:
  • Your fever lasts more than a day
  • You have chest pain or shortness of breath
  • You experience more than a small amount of bleeding when you cough (more than about two tablespoons)
  • Most people are able to resume normal activities within 24 hours

Rigid Bronchoscope

A rigid bronchoscope is a hollow metal tube that allows better access to your lungs. This tube allows the doctors to use larger cameras and more advanced surgical techniques to diagnose and treat lung disease.

What You Can Expect:

  • You will receive general anesthesia, which means you will be in a deep sleep and unable to feel pain
  • The procedure usually is done in an operating room
  • After you are asleep:
  • The bronchoscope is inserted through your mouth and guided into your airways
  • Your oxygen levels are monitored throughout the procedure to make sure you are safe
  • A saline solution may be used to wash the lungs and allow the doctor to collect tissue samples from the lungs.
  • The procedure takes between 30 minutes and 1 hour
  • You will stay at the hospital in the recovery area for 1-2 hours after the procedure

How to Prepare:

  • You may need to take a test before the procedure to make sure you have no problems with blood clotting
  • Talk to your doctor about
  • Any heart problems you have
  • What medications you are taking, and which you may need to stoop before the procedure
  • Whether you need to stop smoking for a time beforehand
  • You will probably not be allowed to eat for 8-12 hours beforehand
  • If you have dentures or a retainer, you will need to remove them
  • You will need someone to take you to and from the hospital, because the medication you are given will make it unsafe for you to drive

What Happens After the Test?

  • You will not be able to eat or drink until you have a normal gag reflex, which takes 1-2 hours
  • After a bronchoscopy there may be some bleeding, but it is usually minor
  • If you have had a biopsy during the bronchoscopy, you may also have a chest x-ray afterwards
  • You will probably need to rest the following day and may experience muscle soreness
  • You may run a fever, but it should last no more than a day
  • Your throat may be hoarse for a few days
  • Call your doctor if:
  • Your fever lasts more than a day
  • You have chest pain or shortness of breath
  • You experience more than a small amount of bleeding when you cough (more than about two tablespoons)
  • Most people are able to resume normal activities within 24 hours
  • You should have someone with you for 24 hours, until the effects of the anesthesia have fully worn off

Endobronchial Ultrasound (EBUS)

This ultrasound technique is used with a flexible bronchoscope to show the surface of airways, blood vessels, lungs, and lymph nodes. It is also a way to gather fluid or tissue samples for analysis. This is a low-risk procedure used to diagnosis lung cancer and other lung diseases.

What You Can Expect:

  • You will be given medication to relax you, or general anesthesia, which puts you in a deep sleep an intravenous sedative or general anesthesia
  • Your oxygen levels, heart rate and blood pressure will be monitored
  • An anesthetic will be used to numb your mouth and throat
  • You may cough after it has been inserted, but that will subside
  • You should not feel pain during this procedure
  • This test also uses ultrasound, which uses soundwaves to produce images of the outside of the lungs
  • This is usually an outpatient procedure, but some people do stay overnight
  • The procedure takes about 30 minutes, but including the preparation and recover, you will be there about 4 hours

How to Prepare:

  • You may need to take a test before the procedure to make sure you have no problems with blood clotting
  • Talk to your doctor about
  • Any heart problems you have
  • What medications you are taking, and which you may need to stoop before the procedure
  • Whether you need to stop smoking for a time beforehand
  • You will probably not be allowed to eat for 8-12 hours beforehand
  • If you have dentures or a retainer, you will need to remove them
  • You will need someone to take you to and from the hospital, because the medication you are given will make it unsafe for you to drive

What Happens After the Test?

  • You will not be able to eat or drink until you have a normal gag reflex, which takes 1-2 hours
  • After a bronchoscopy there may be some bleeding, but it is usually minor
  • If you have had a biopsy during the bronchoscopy, you may also have a chest x-ray afterwards
  • You will probably need to rest the following day and may experience muscle soreness
  • You may run a fever, but it should last no more than a day
  • Your throat may be hoarse for a few days
  • Call your doctor if:
  • Your fever lasts more than a day
  • You have chest pain or shortness of breath
  • You experience more than a small amount of bleeding when you cough (more than about two tablespoons)
  • Most people are able to resume normal activities within 24 hours
  • You should have someone with you for 24 hours if general anesthesia is used, until the effects of the anesthesia have fully worn off

Navigational Bronchoscopy

This test combines navigation technology with three-dimensional imaging techniques to get to narrower places around the lungs that a flexible bronchoscope alone can’t reach. This minimally invasive test can find tumors, take biopsies and give treatment.

What You Can Expect:

  • You will have a computed tomography (CT) scan done before the procedure to locate potential tumors
  • During the navigational bronchoscopy you will:
  • Lie on an electromagnetic surface
  • The tube of the flexible scope, which is less than a half an inch wide and two feet long, is inserted through your mouth or nose and into your lungs
  • You will probably be given medication to help you relax, and you may sleep through the procedure
  • Your oxygen levels and other vital signs will be monitored at all times to keep you safe
  • An anesthetic will be used to numb your mouth or nose and throat
  • You may feel like you have to cough after the tube has been inserted, but that will go away
  • You should not feel pain during this procedure
  • Once target lesions are reached, small surgical tools pass through the bronchoscope to collect a tissue sample for diagnosis
  • This is usually an outpatient procedure, but some people do stay overnight

How to Prepare:

  • You may need to take a test before the procedure to make sure you have no problems with blood clotting
  • Talk to your doctor about
  • Any heart problems you have
  • What medications you are taking, and which you may need to stoop before the procedure
  • Whether you need to stop smoking for a time beforehand
  • You will probably not be allowed to eat for 8-12 hours beforehand
  • If you have dentures or a retainer, you will need to remove them
  • You will need someone to take you to and from the hospital, because the medication you are given will make it unsafe for you to drive

What Happens After the Test?

  • You will not be able to eat or drink until you have a normal gag reflex, which takes 1-2 hours
  • After a bronchoscopy there may be some bleeding, but it is usually minor
  • If you have had a biopsy during the bronchoscopy, you may also have a chest x-ray afterwards
  • You will probably need to rest the following day and may experience muscle soreness
  • You may run a fever, but it should last no more than a day
  • Your throat may be hoarse for a few days
  • Call your doctor if:
  • Your fever lasts more than a day
  • You have chest pain or shortness of breath
  • You experience more than a small amount of bleeding when you cough (more than about two tablespoons)
  • Most people are able to resume normal activities within 24 hours

Airway Stent (bronchial stent)

This is a tube that is placed in your airway to open an area that has narrowed due to lung disease. The stent keeps the airway open, allowing adequate airflow. It is placed there with a bronchoscope. Stents are made from different materials such as silicone, metal and hybrid stents that combine materials. They vary in size and shape and can be permanent or removable.

What You Can Expect:

  • This procedure can be done using flexible or rigid bronchoscopy. Please look at those sections for what to expect, how to prepare, and what happens after the test.

What Happens After Stent Placement:

  • If you develop new symptoms, such as a cough, call your doctor
  • Follow up with your doctor is very important after a stent has been placed to prevent any complications

Balloon Bronchoplasty

This procedure delivers a deflated balloon into a narrow airway using flexible or rigid bronchoscopy procedure. Once it is in the right place, the balloon is inflated and remains in place for a short time. This process is repeated several times using larger and larger balloons, causing the narrowed airway to expand. Sometimes this is done along with a stent procedure.

What You Can Expect:

  • This procedure can be done using flexible or rigid bronchoscopy. Please look at those sections for what to expect, how to prepare, and what happens after the test.