Aerosol Use in the Pulmonary Function Lab

Abstract

Aerosols in the Pulmonary Aerosols in the Pulmonary Function Testing LabAerosolized agents are an essential component of pulmonary function testing (PFT). 1 Inhaled bronchodilators are widely used to assess reversibility of airway obstruction, particularly in patients suspected of having asthma. 2 Measurement of the FEV 1 /FVC ratio after administration of a ␤ agonist is the de facto test to establish the diagnosis of COPD. 3 Similarly, measurement of FEV 1 following bronchodilator administration is used to categorize the severity of airway obstruction. Improvement in air flow is the primary end point in the evaluation of new inhaled bronchodilators, and PFT provides the necessary tools for assessment. The other primary use of aerosols in the PFT lab involves inhaled bronchial challenge agents. As is the case for bronchodilators, bronchial provocation using an aerosolized agent is a key tool for making or excluding the diagnosis of asthma. 4 Inhalation of challenge aerosols also provides a means to quantify the degree of hyper-responsiveness. How Aerosols Are Administered in the PFT Lab BronchodilatorsBronchodilators can be administered by various methods for diagnostic purposes. Typically, a ␤ agonist or anMr Ruppel is affiliated with the Division

International consensus on lung function testing during the COVID-19 pandemic and beyond

“…Mannitol may cause significant cough and/or throat irritation in some individuals [93]. Cough is a common side effect of mannitol challenge tests possibly due to the combination of the low resistance device, and a high inspiratory flow, and can result in cough through a mechanical cough reflex due to oropharyngeal deposition of the mannitol [94].…”

Area under the inspiratory flow-volume curve (AIN): Proposed normative values

“…Historically, respiratory function evaluation had focused mainly on forced maximal expiratory volumes and airflows [ 6 ]. This may have been due, at least in part, to the fact that functional assessment is less sensitive at higher lung volumes, that the inspiratory resistance to airflow does not factor in the (passive) elastic recoil of the respiratory system, and that the measurement is more influenced by the magnitude of the (active) respiratory effort.…”

“…To date, respiratory function evaluation focuses largely on volumes and airflows measured during forced expiratory maneuvers, without much consideration to inspiratory mechanics, leading some to call the oversight of inspiratory flow as ‘the neglected child of pulmonary diagnostics’ [ 6 ]. Furthermore, standards for test performance regarding the inspiratory limb of the flow-volume curve have also received little attention.…”