Lung-function testing

For some substances, information on some toxicological endpoints is available from clinical and physiological investigations such as provocation tests for detecting allergy, lung function tests, and analyses of biochemical parameters and biomarkers for exposure or effects. 

A list of procedures comprising a medical screen is given in Box 4.9. Particular studies may require additional procedures, such as lung function tests, coagulation studies, exercise or 24 h ECG or a psychiatric interview. 

In humans, -butyl acetate affected the throat at 200 ppm severe throat irritation occurred at 3 00 ppm, and the majority of the subjects also complained of eye and nose irritation. Only slight eye and pulmonary irritation (as determined by lung function tests) were observed in volunteers exposed to 1400 mg/m for 20 minutes or 700mg/m for 4 hours. ... 

The effects of ozone appear to be cumulative for initial exposures followed by adaptation. Five of six subjects exposed to 0.5 ppm ozone 2 hours/day for 4 days showed cumulative effects of symptoms and lung function tests for the first 3 days, followed by a return to near control values on day 4." In animals exposure to 0.3-3 ppm for up to 1 hour permits the animals to withstand multilethal doses for months afterwards. However, repeated exposures impart protection from all forms of lung injury (e.g., susceptibility to infectious agents, enzyme activities, inflammation). Initial ozone exposure may act to reduce cell sensitivity and/or increase mucus thickness, factors which may modify the accessibility and action of the gas. It is not known how variations in the length, frequency, or magnitude of exposure modify the time course for tolerance. 

A systematic review of six trials involving a total of 55 people concludes that caffeine appears to improve airways function modestly in people with asthma for up to four hours. People may need to avoid caffeine for at least four hours prior to lung function testing. 

Lung function testing is not reliable for children 5 years and younger. 

Pellegrino R, Viegi G, Brusasco V et al. Series ATS/ERS task force standardisation of Lung function testing . Interpretative strategies for lung function tests. Eur RespirJ 2005 26 948-68. 

Xenon has a large number of isotopes, many of which are naturally occurring. The only isotope of medical importance is 133Xe which is used in the measurement of regional cerebral blood flow and in lung function testing. 

All patients were monosensitized with a persistence of symptoms despite action to eliminate mites and treatment with inhaled corticosteroids. Patients were included after an 8-week observation period which made it possible to determine the lowest effective dose of budesonide, with the performance of skin tests, lung function tests and a methacholine bronchial challenge test. The efficacy criteria were the medication and symptom scores, global assessment of the patient by the physician, skin tests and total IgE, lung function tests and the methacholine bronchial challenge test. 

Hyperinflation of the lung by vigorous exercise or repeatedly performing lung function tests may also lead to increased membrane permeability, possibly resulting from a disturbance of the intercellular junctions. 

Kilian U, Beume R, Eltze M, Hafner D, Hanauer G, Schudt C. Telenzepine and its enantiomers, Ml-selective antimus-carinics, in guinea pig lung function tests. Agents Actions Suppl., 1991, 34, 131-147. 

On arrival at hospital, although wheezing and breathless, Mandy could describe her usual medication to staff. A blood test showed that her arterial pH was 7.25 and lung function tests produced the results indicated below. 

Bill has smoked for 45 years and has a chronic, productive cough. He is now very short of breath. He first noticed this when he was walking uphill, but now he is short of breath walking on the flat. In the last few years, he has had a couple of chest infections, which were successfully treated with antibiotics. His doctor prescribed an inhaler last year but it made little difference to his breathing. Bill s latest lung function test is shown below. 

Q3 Chandra has suffered recurrent chest infections for three years and has had a chronic cough with sputum production during this time. Although he is not a smoker, he has been exposed to occupational dusts in the mining industry, which is known to be associated with development of COPD. His lung function test results are consistent with this diagnosis (see Part 2 of the case study). 

BLEOMYCIN ANTICANCER AND IMMUNOMODULATING DRUGS-CISPLATIN t bleomycin levels, with risk of pulmonary toxicity Elimination of bleomycin is delayed by cisplatin due to 1 glomerular filtration. This is most likely with accumulated doses of cisplatin in excess of 300 mg/m2 Monitor renal function and adjust dose of bleomycin as per creatinine clearance. Monitor clinically, radiologically and with lung function tests for pulmonaiy toxicity... 

MITOMYCIN CYTOTOXICS-VINCA ALKALOIDS t risk of abrupt onset of pulmonaiy toxicity in 3-6% of patients, when two courses of these drugs are administered concurrently Mechanism is uncertain possible additive pulmonary toxic effects Monitor clinically and with lung function tests for pulmonary toxicity. Advise patients to report immediately symptoms such as shortness of breath and wheezing... 

Following the explosion at the World Trade Center (WTC) on September 11, 2001, various public health concerns arose regarding the air quality. Researchers believe that the explosion may account for adverse health effects in the workers and residents in the environment around the WTC. As a result, researchers from Johns Hopkins University, New York University, and Columbia University have monitored truck drivers exposed to the dust, fires, and air pollutants in the WTC aftermath. Phase I focused on the exposure of truck drivers from the disaster site, and Phase 11 focused on the respiratory health of the workers at the disaster site. Interviews and lung function tests were conducted to evaluate changes in lung function or symptoms (Community Update, 2002). Current research is under way addressing the aftereffects of exposure to dust in the air from the World Trade Center disaster. 

In lung function tests, high-dose aerosolized pentamidine (600 mg/month) was associated with an increased pulmonary residual volume, reduced flow rates, and increased airway reactivity (SEDA-18, 291). 

The manufacturers have on record in the USA several pulmonary adverse effects during isotretinoin therapy, including worsening of asthma (SEDA-21,162), recurrent pneumothorax, pleural effusion, interstitial fibrosis, pulmonary granuloma, and deterioration in lung function tests. Exercise-induced asthma (35) may be caused by a significant reduction in the forced expiratory flow rate (36) and a drying effect of isotretinoin on the mucous membranes of the respiratory tract (37). 

Figure 2. Results of lung function tests expressed as per cent deviation from normal in relationship to concentration of ozone...

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