Pulmonary function laboratory

In pulmonary function laboratories, histamine aerosol has been used as a provocative test of bronchial hyperreactivity. Histamine has no other current clinical applications. 

The purpose of a pulmonary function laboratory is to obtain clinically useful data from patients with respiratory dysfunction. The pulmonary function tests (PFTs) within this laboratory fulfill a variety of functions. They permit (1) quantification of a patient s breathing deficiency, (2) diagnosis of different types of pulmonary diseases, (3) evaluation of a patient s response to therapy, and (4) preoperative screening to determine whether the presence of lung disease increases the risk of surgery. 

Putting the preceding discussions into practice is the everyday mission of the pulmonary function laboratory, a common clinical unit designed to make respiratory measurements on hospital patients and research subjects. Some of the most common measurements and the devices used to make them will be described below. 

Wanger, J. (ed.), 1998, Pulmonary Function Laboratory Management and Procedure Manual, American Thoracic Society, New York. 

Pulmonary circulation, 7-4-7-5 Pulmonary function laboratory, 7-12-7-16 spirometry in, 7-12-7-14... 

Laboratory evaluations include complete blood cell and reticulocyte counts and HbF level. Renal, hepatobiliary, and pulmonary function should be evaluated. Patients should be screened for retinopathy. 

O Neil, J.J. and Raub, J.A., Pulmonary function testing in small laboratory animals, Environ. Health Perspect., 56, 11-22, 1984. 

Occupational medical records should record and document occupationally related medical information of all types (e.g., medical examinations, visits to medical facilities [even for nonoccupational reasons], clinical laboratory data, injuries, pulmonary function tests, audiograms, etc.). The period of time that records must be retained is specified by law depending on the type of data and the health-related agent(s) of concern. In most cases, OSHA requires that information be retained for at least 30 years after the termination of employment (OSHA Standard 29 CFR 1910.1020 Access to Employee Exposure and Medical Records). Medical records should be kept in compliance with the OSHA... 

Blood plasma of children with cystic fibrosis was found to have decreased TAC (by 16%) in spite of increased concentrations of ascorbic acid, uric acid, and thiol groups (L4). In another study TAC of children with cystic fibrosis was normal, but these children received vitamin supplementation in doses prescribed in international guidelines (a-tocopherol <10 years, 100 mg daily, and >10 years, 200 mg daily retinol 2.5 mg daily ascorbic acid 100-200 mg daily) (M2). Other authors found TAC values for nonhospitalized patients (1.40 0.20 mM) not different from laboratory control values (1.35 0.11 mM), but greater than values for hospitalized patients (1.09 0.17 mM). TAC in CF children correlated positively with anthropometric values (height, weight, body mass index) and pulmonary function (forced expiratory volume in 1 sec), but not with age (L3). 

Kerr, H.D., T.I.Kulle, M.L.McIIhany, and P.Swidersky. 1978. Effects of Nitrogen Dioxide on Pulmonary Function in Human Subjects, An Environmental Chamber study. EPA/6001/1-78/025. Office of Research and Development, Health Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, NC. 20pp. 

The safety and tolerability of once-daily oral metrifonate has been evaluated in patients with probable mild to moderate Alzheimer s disease in a randomized, doubleblind, placebo-controlled, parallel-group study (9). Metrifonate was given to 29 patients as a loading dose (2.5 mg/kg) for 2 weeks, followed by maintenance dose (1 mg/kg) for 4 weeks 10 patients received placebo. The proportion of patients who had at least one adverse event was comparable in the two groups metrifonate 76%, placebo 80%. Selected adverse events, defined as those for which the incidence in the metrifonate and placebo group differed by at least 10%, were diarrhea, nausea, leg cramps, and accidental injury. The adverse events were predominantly mild and transient. Those who took metrifonate had a significantly lower heart rate. Metrifonate had no clinically important effect on laboratory tests, such as liver function tests, and did not affect exercise tolerance or pulmonary function. 

Miller WF, Scacci R, Gast LR. Laboratory Evaluation of Pulmonary Function. New York J. B. Lippincott, 1987. 

For patients who consistently demonstrate clinical limitation in airflow, a therapeutic challenge of bronchodilators (such as albuterol aerosol) should be considered. Pulmonary function tests can be performed before and after 82-agonist aerosol administration to determine more objectively a patient s propensity to benefit from supplemental aerosol therapy. However, this laboratory assessment, often performed at times of better health, may not accurately predict a patient s potential benefit from P2 aerosols during an acute exacerbation of chronic bronchitis. 

Enzyme replacement for exocrine pancreas insufficiency must be adjusted on an individual basis considering age, body weight, weight for height, growth rate, fat intake, supplementary energy needs (particularly for pulmonary function), and clinical as well as laboratory evidence of malabsorption. Clinical symptoms include abdominal pain, distension, intolerance of fatty foods, and character of stools (consistency, number, odor). A more objective assessment involves microscopic examination of stool for neutral and split fats, measurement of fecal chymotrypsin or elastase [96]. 

B. Other useful laboratory studies include CBC with differential, platelet count, electrolytes, glucose, BUN and creatinine, liver enzymes, and prothrombin time (PT). ECG may be indicated for cardiotoxic agents, and pulmonary function tests are indicated for agents with known pulmonary toxicity. 

B. Other useful laboratory studies include chest x-ray, arterial blood gases, and pulmonary function tests. 

C. General laboratory testing tor chronic exposure assessment should be driven by the potential organ toxicity delineated previously. Standard recommendations (eg, in NIOSH criteria documents) often include a complete blood count, electrolytes, tests of renal and liver function, and periodic chest radiographic and pulmonary function studies. 

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