Pulmonary Function Lab

On Behalf of Dr. Chupp, Myself and the Staff, welcome to the Pulmonary Function Lab!

In addition to the staff and the directions here are a few facts about our PFT LAB.

This lab was built on the development and innovation of Physicians, Respiratory Therapist, and engineers who pursued the desire to understand the function of the lungs by capturing and documenting the measurements of flows, and gas exchange. From spirograph, to electronic, to digital, this lab has always moved its testing into the future.

From building one of the first Plethysmographs in the world, to traveling around the country and collecting a normal value data base, the staff of the Pulmonary Function lab has always partnered with the leading Physicians to improve and understand the quality of lung function and health.

The focus of the lab has always shifted to meet the needs of this community it serves. As the tests been developed and applied the labs focus has moved from developing equipment to clinical and research applications.

Under the guidance and support of Dr. Geoffrey Chupp we have tripled the number of studies in the last 8 years to Performing over 9000 test each year on over 3000 patients. We will continue to develop and grow in this same spirit.

Fondly,

Susan Soule
Manager

Overview of Pulmonary Function Testing

The Yale New Haven Health System Pulmonary Lab performed over 5,000 tests in 2013. We presently have 5 Registered Respiratory Therapists, who are specially trained in performing pulmonary function testing. Our lab now includes the SRC (St. Raphael’s Campus) and will soon include the Smilow Cancer Center lab.

We offer the following types of pulmonary function tests:

  • Spirometry with or without bronchodilator
  • MVV (maximum voluntary ventilation)
  • MEP/MIP (maximum expiratory & maximum inspiratory pressures)
  • FENO (fractional exhaled nitric oxide)
  • Lung volumes by either helium dilution or plethysmography
  • Diffusion capacity
  • Arterial blood gases
  • Six minute walking test for oxygen titration
  • HAST- high altitude simulation testing
  • Estimated Shunt Study
  • C.P.E.T. (Cardiopulmonary exercise test)
  • Methacholine Bronchial Challenge
  • Aridol Bronchial Challenge

Indications for Testing

Below are some indications that you should perform pulmonary function testing:

  • Asthma
  • COPD
  • ILD (interstitial lung disease)/Restrictive lung disease
  • Bronchitis
  • Pre-operative evaluation
  • Pre-transplant evaluation
  • Neuromuscular issues
  • Hypoxemia on exertion
  • Differentiating cardiac vs. pulmonary issues
  • Cough
  • Cystic fibrosis
  • Dyspnea
  • Scleroderma

Other Procedures

  • Spirometry (with or without bronchodilator)
    Spirometry is a test that requires forced exhalation, and measures both the flow (the speed) and the volume of air exhaled.
  • MVV
    Measures the maximal amount of air that you can inhale and exhale in about 12 seconds. This may be useful in the overall diagnosis of asthma, or suspected neuromuscular issues.
  • MEP/MIP
    These are maximal inspiratory and expiratory pressures and can be useful in the diagnosis of neuromuscular weakness. You will be asked to exhale as forcefully as possible for a couple of seconds, and inhale as forcefully as possible, again for just a couple of seconds.
  • FENO
    This is a measurement of how much nitric oxide you exhale; it is an indication of inflammation in the airways. FENO can be useful in the diagnosis of asthma or allergic asthma, and in their management. You will be asked to take a normal breath in, exhale fully, then place your mouth on a mouthpiece, inhale fully and exhale slowly, for 5-7 seconds into an analyzer.
  • Lung Volumes by either helium dilution or plethysmography
    Measures the total volume of air in the lungs and in plethysmography will also measure airway pressures. Both tests involve some normal breathing, taking a big easy breath in and then exhaling all the way out. Plethysmography also involves short periods of panting into the mouthpiece.
  • Diffusion capacity
    This test measures how well the oxygen passes through the lung membrane to be picked up by the blood (gas exchange). It involves normal breathing followed by big easy breath, both in and out, a fast big breath in, hold for a few seconds, then blow it all the way out.
  • Arterial blood gases
    This test measures the levels of both carbon dioxide and oxygen in the arterial blood; it also measures the acidity (pH) of the blood.
  • Six minute walking test for oxygen titration
    The walking test measures your oxygen saturation and heart rate before, during and after the testing. It is done to evaluate your level of oxygen saturation while you walk, to see if you need oxygen support on exertion. It also will measure how far you walk in a certain period of time and your level of shortness of breath on exertion.
  • HAST: High Altitude Simulation Testing
    This test simulates the oxygen level while you are flying, it will determine if you need oxygen on the plane, and if so, how much oxygen you need. You will be sitting comfortably, with a mouthpiece in, breathing normally, for about 20 min., with your oxygen saturation and heart rate being monitored. If at any point your oxygen saturation drops below an acceptable level, oxygen will be added, as needed.
  • Estimated Shunt Study
    Measures the portion of blood flow that does not participate in normal gas exchange in the lungs. You will be sitting comfortably, breathing 100% oxygen, through a mouthpiece for approximately 20 minutes. At that time an arterial blood gas will be drawn.
  • CPET: Cardiopulmonary Exercise Test
    This is a more complicated type of exercise test; it will measure how much oxygen you consume and how much carbon dioxide you produce, while exercising on a bicycle. All this will measured, along with your EKG,  oxygen saturation, and blood pressure during the testing period, which could be anywhere from 5-12 minutes, depending on your fitness level. This type of testing could help determine why you are short of breath, having decreased exercise tolerance, or help to distinguish between pulmonary and cardiac problems.
  • Methacholine Bronchial Challenge
    This test helps with the overall diagnosis of the patient to determine if they have asthma or not. You are asked to inhale, in increasing doses, the methacholine. During this time you will perform the spirometry test several times, between each dose. If at any point your spirometry test drops by 20%, the test will be stopped and you will be administered albuterol, a bronchodilator (usually used in the treatment of asthma). The spirometry test will be repeated to ensure reversal of the drop in airway function.
  • Aridol Bronchial Challenge
    This test helps in the diagnosis or exclusion of asthma. You will be asked to inhale Aridol, in increasing doses, between which you will perform the spirometry test. If at any point your spirometry drops by 15%, the test will be stopped and you will be administered, albuterol (a medication usually used with asthma). The spirometry will then be repeated to ensure that your spirometry has returned to normal.

Preparations for Testing

  • For any exercise testing wear loose fitting clothing and comfortable shoes, eat a small meal 1-2 hrs. prior to testing and bring a list of your medications.
  • If you take inhalers for your breathing, try not to take them 4 hours prior to testing. 
  • If you are having a methacholine or Aridol bronchial challenge there will be specific instructions prior those tests. Call the office if you have not received them.
  • Do not eat a large meal prior to any of the tests.
  • If you are a smoker, refrain from smoking the day of the test
  • There are more specific instructions for a CPET (cardiopulmonary exercise stress test), please call the office if you have not received them.

No, they do require some work with different breathing maneuvers, so may cause some shortness of breath, slight dizziness. You will be closely monitored by staff, and they will stop the test, to let you rest whenever needed.

Arterial blood gases are uncomfortable, as are any blood draws.

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In our experience, most people can perform the tests; they may require more frequent rest periods, which staff will accommodate.

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The tests are usually best when done at your normal baseline, not with a cold.

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Generally, we like for you to hold any inhalers the day of test. However, for a CPET, Aridol or Methacholine bronchial challenges there are specific instructions. You should receive the instructions from your physician prior to testing, if not, please feel free the call our office.

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