Diagnostic Testing at U-Breathe

Pulmonary Function Testing

Pulmonary Function Testing (PFTs) is a comprehensive series of non-invasive tests to objectively measure how well the lungs are working. The tests measure lung volumes, rates of flow, and gas exchange. Most common tests include Spirometry, diffusion capacity(DLCO), and body plethysmography. Sometimes only one test is performed, other times all the tests may be completed. 

The tests will provide the following information:

  • Assist in making a diagnosis of various chronic conditions of the respiratory system,
  • Compare the lung function of the person to their predicted values, showing how well the lungs should be working in a healthy person,
  • Identify changes in lung function that require treatment or intervention
  • Decide which medicine would be helpful to alleviate respiratory symptoms
  • Determine the patient’s ability to tolerate surgical procedure or treatment
  • Evaluate the effectiveness of the current treatment

Test Preparation

Prior to testing, please review the following questions:

  1. Have you had a Myocardial Infarction (heart attack), or Cerebral Vascular Accident (Stroke), within the last month?
  2. Are you actively coughing up blood currently?
  3. Have you any surgery or procedure done within the last 6-8 weeks?

If you have answered “Yes” to any of the three questions above,

Please contact our office regarding your test appointment.

What to expect from my visit and what do I need to bring?

  • Please come to the clinic 15 minutes before your appointment to fill in registration forms
  • Please bring your healthcare card and one other form of identification
  • If you are on any prescription medications, please bring a list of all the prescription medications you are currently taking

If this is your first test, please read the following preparation steps prior to your test:

  • If you are on any inhalers or respiratory medications
    • Please withhold those medications at least 24 hours prior to your test
    • Please record the name of the medication you take
  • Please withhold from any caffeine product (coffee, tea, soda, chocolate, etc.) at least 4 hours prior to testing
  • If you currently smoke, please without from smoking for at least 4 hours prior to testing.
  • Please do not have any heavy meals prior to testing, a light meal is allowed

If you are scheduled for follow-up testing at U-Breathe, please read the following preparation steps:

  • If you have been started on inhalers or respiratory medications after your initial consultation, please continue to use your medications.
  • If there is any change in your prescription medications since your previous visit, please record the updated list of prescription medications you currently take.
  • Please withhold from any caffeine product (coffee, tea, soda, chocolate, etc.) at least 4 hours prior to testing
  • If you currently smoke, please without smoking for at least 4 hours prior to testing.
  • Please do not have any heavy meals prior to testing, a light meal is allowed

Call our office if you:

  • Develop a lung infection, a cold, or the flu. If you have had any of these, you may need to have the test rescheduled.
  • Need to change your appointment.
  • Have any questions or concerns regarding your breathing test.

Spirometry

Spirometry is a test to measure lung volumes and rates of flow.
It is one part of a comprehensive pulmonary function test (PFT) to assess the health of your lungs.

Spirometry is a physiological test that measures inhaled and exhaled volumes of air as a function of time.  The primary signal measured in spirometry is volume or flow. Spirometry measures the vital capacity (VC), the largest volume of air that can either be inspired or expired from the lungs.  VC measured from a maximal forced exhalation is called the forced vital capacity (FVC).  The most commonly measured parameters from the FVC maneuver are the FVC itself and the forced expiratory volume in one second (FEV1).  Various flows can be measured in conjunction with an FVC maneuver, either at specific points or across specific intervals.

Test Preparation

Prior to testing, please review the following questions:

  1. Have you had a Myocardial Infarction (heart attack), or Cerebral Vascular Accident (Stroke), within the last month?
  2. Are you actively coughing up blood currently?
  3. Have you any surgery or procedure done within the last 6-8 weeks?

If you have answered “Yes” to any of the three questions above,

Please contact our office regarding your test appointment.

What to expect from my visit and what do I need to bring?

  • Please come to the clinic 15 minutes before your appointment to fill in registration forms
  • Please bring your healthcare card and one other form of identification
  • If you are on any prescription medications, please bring a list of all the prescription medications you are currently taking

If this is your first test, please read the following preparation steps prior to your test:

  • If you are on any inhalers or respiratory medications
    • Please withhold those medications at least 24 hours prior to your test
    • Please record the name of the medication you take
  • Please withhold from any caffeine product (coffee, tea, soda, chocolate, etc.) at least 4 hours prior to testing
  • If you currently smoke, please without from smoking for at least 4 hours prior to testing.
  • Please do not have any heavy meals prior to testing, a light meal is allowed

If you are scheduled for follow-up testing at U-Breathe, please read the following preparation steps:

  • If you have been started on inhalers or respiratory medications after your initial consultation, please continue to use your medications.
  • If there is any change in your prescription medications since your previous visit, please record the updated list of prescription medications you currently take.
  • Please withhold from any caffeine product (coffee, tea, soda, chocolate, etc.) at least 4 hours prior to testing
  • If you currently smoke, please without smoking for at least 4 hours prior to testing.
  • Please do not have any heavy meals prior to testing, a light meal is allowed

Call our office if you:

  • Develop a lung infection, a cold, or the flu. If you have had any of these, you may need to have the test rescheduled.
  • Need to change your appointment.
  • Have any questions or concerns regarding your breathing test.

Methacholine Challenge Test (MCT)

 – What is a methacholine challenge test?

  • A Methacholine Challenge Test is a lung function test done to see how sensitive your lungs are (airway responsiveness).  If you have hyper-responsive airways, your breathing passages can get narrow (bronchospasm), it may get hard to breathe and will be visible on the test results.  Methacholine is the name of the medicine used for the test. You will be given inhalations of the bronchodilator salbutamol which will reverse this narrowing.
  • If you are pregnant or breastfeeding, you should not have a methacholine challenge test.

 – Do I need to stop taking any of my medicines before the test?

  • There are medications you may need to stop taking prior to your test (see below). Call our office if you are not sure if you can take any breathing medicine or if you had to take any of the medicines listed below.
  • If you are concerned about your breathing worsening and have not been able to stay off any of the medications, please let us know. 
  • The test may still be performed and the use of your medication will be documented and included in the report.
  • If you are currently on Omalizumab (Xolair), please inform the clinic and your doctor. We will assess the need for the Methacholine test.

  **Avoid smoking, coffee, tea, cola drinks, and chocolate on the day of the test.

 – – – Call our office at 403-475-9766 if you:

  • Develop a lung infection, a cold, or the flu. If you have had any of these, you may need to have the test rescheduled.
  • Need to change your appointment.
  • Have any questions or concerns.

There are some medications that you should stop taking before your test

- - - Stop taking 1 to 2 weeks before testing:

  1. Fluticasone and salmeterol (Advair®)
  2. Triamcinolone (Azmacort®)
  3. Beclomethasone (QVAR®, Vancenase®, Vanceril®)
  4. Fluticasone (Flonase®, Flovent®)
  5. Methylprednisolone (Medrol®)
  6. Ciclesonide (Alvesco ®)
  7. Budesonide and Formoterol (Symbicort®)
  8. Fluticasone and Vilanterol (Breo ®)
  9. Mometasone and Fomoterol (Zenhale ®)
  10. Budesonide (Pulmicort®)
  11. Prednisone

 - - - Stop taking at least 1 week before testing:

  1. Tiotroprium (Spiriva®)
  2. Glycopyrronium (Seebri®)
  3. Umeclidinium and Vilanterol (Anora®)
  4. Tiotropium and Olodaterol (Inspiolto®)
  5. Aclidinium and Formoterol (Duaklir®)

 - - - Stop taking 4 days (96 hours) before testing: 

  1. Loratadine (Alavert®, Claritin®)
  2. Fexofenadine (Allegra®)
  3. Triamcinolone (Aristocort®, Azmacort®)
  4. Azelastine (Astelin®)
  5. Hydroxyzine (Atarax®)
  6. Diphenhydramine (Benadryl®)
  7. Brompheniramine and pseudoephedrine (Bromfed®)
  8. Chlorpheniramine and pseudoephedrine (Chlor-Trimeton®)
  9. Desloratadine (Clarinex®)
  10. Acetaminophen, phenylpropanolamine hydrochloride, chlorpheniramine maleate, and dextromethorphan hydrobromide (Comtrex®)
  11. Clemastine (Dayhist®)
  12. Pseudoephedrine (Dimetapp®)
  13. Pseudoephedrine and brompheniramine (Dristan®)
  14. Clemastine (Tavist®)
  15. Cetirizine (Zyrtec®)
  16. Triprolidine and pseudoephedrine (Actifed®)

 - - - Stop taking at least 2 days (48 hours) before testing:

  1. Formoterol (Foradil®, Oxeze®)
  2. Hydroxyzine, theophylline, ephedrine (Marax®)
  3. Salmeterol (Serevent®)
  4. Indacaterol (Onbrez®)

 - - - Stop taking at least 1 day (24 hours) before testing:

  1. Epinephrine (Adrenalin®, MicroNefrin®, Primatene®)
  2. Ipratropium (Atrovent®)
  3. Terbutaline (Brethine®, Bricanyl®)
  4. Ipratropium and albuterol (Combivent®, DuoNeb®)
  5. Isoproterenol (Isuprel®)
  6. Montelukast (Singulair®)
  7. Accolate (Zafirlukast®)
  8. Albuterol or salbuterol (AccuNeb®, Proventil®, Ventolin®, Volmax®)
  9.  Zileuton (Zyflo®)

**Avoid smoking, coffee, tea, cola drinks, and chocolate on the day of the test. **

Fraction of Exhaled Nitric Oxide (FeNO) Concentration

Indications for Testing:
NIOX VERO Airway Inflammation Monitor NIOX VERO® measures
Nitric Oxide (NO) in the breath. Nitric Oxide is frequently elevated in some airway inflammatory processes, such as asthma. The fractional NO concentration in expired breath (FeNO), can be measured by NIOX VERO. This test will be used in conjunction with other tests and to find the cause of your symptoms.

What to expect during this procedure:

The measurement of FeNO by NIOX VERO is a quantitative, non-invasive, simple and safe method to measure the FeNO concentration. The procedure consists of a short breathing test guided by a Respiratory Therapist.

Preparation:

  • Since this procedure is not covered by Alberta Health Services, you would be
    responsible for the cost of the test in the amount of $40.00 per test
    CASH ONLY
  • Please do not eat or drink (except for water) for 1 hour prior to the test.
  • Please do not smoke for 1 hour prior to the test
  • Please avoid exercise for 1 hour prior to the test
  • If you are currently taking any asthmatic medications, please contact us to see if
    any medications should be withheld prior to testing.
    Call our office at (403) 475-9766 if you:
    Develop a lung infection, a cold, or the flu. If you have had any of these, you may
    need to have the test rescheduled.
    Need to change your appointment.
    Have any questions or concerns about the test procedure

Arterial Blood Gas (ABG)

What is an Arterial Blood Gas (ABG) test?

An Arterial Blood Gas (ABG) test measures the amounts of arterial gases, such as oxygen and carbon dioxide, as well as assessing other blood markers. The test requires that a small volume of blood be drawn from the radial artery with a syringe and a thin needle. In addition, arterial oxygen saturation can be determined. Such information is vital when caring for patients with respiratory diseases who may be potential candidates for home oxygen therapy.

What should I expect from my visit and what do I need to bring?

  • Please come to the clinic 15 minutes before your appointment to fill in registration forms
  • Please bring your healthcare card and one other form of identification
  • If you are on any prescription medications, please bring a list of all the prescription medications you are currently taking
  • If you are currently on home oxygen, please bring your portable oxygen cylinder or concentrator to your appointment.
  • You can expect to be at our clinic for 30 to 45 minutes for your appointment
  • There is a pay parking lot on site, please plan for enough time to allow for parking

Cardiopulmonary Exercise Testing (CPET)

Cardiopulmonary exercise testing (CPET) involves pedalling on a stationary bicycle while monitoring its effects on your breathing, heart and muscles.

We will analyze the concentrations of oxygen and carbon dioxide as well as monitor your EKG/ECG during this procedure. Along with the doctor, there will be a therapist in the room with you. 

Why did my doctor order this test?

Some reasons for cardio-pulmonary exercise testing include:

  • evaluation of shortness of breath;
  • functional status determination in congestive heart failure;
  • pre-operative risk assessment;
  • disability determination;
  • often before starting a pulmonary rehabilitation program;
  • response to therapeutic interventions; and/or
  • the development of exercise prescriptions.

At U-Breathe we look forward to offering this test in the near future!

6 Minute Walk test

The 6-minute walk test (6MWT) measures the distance that a patient can walk quickly on a flat hard surface in a period of 6 minutes (the 6MWD).

The 6MWT evaluates the global and integrated responses of all body systems involved during exercise. It does not provide specific information on the function of each of the different organs and systems involved as is possible with the cardiopulmonary exercise test (CPET). Most patients do not achieve maximal exercise capacity during the 6MWT, and instead, choose their own level of intensity.

Why did my doctor order this test?
  • Pretreatment and post-treatment comparisons
  • Functional status (single measurement)
  • Predictor of morbidity and mortality
Pre-Test Instructions
  • Wear loose-fitting, comfortable clothing and shoes suitable for exercise
  • Patients should use their usual walking aids during the test (cane, walker, etc.)
  • A light meal is acceptable before early morning or early afternoon tests.
  • Patients with respiratory and/or cardiac disease are instructed to use all regular medications as ordered on the normal daily schedule

MIPs and MEPs

The measurement of respiratory muscle forces (or strength), maximum inspiratory pressure (MIP or PImax), and maximum expiratory pressure (MEP or PEmax), are direct tests that are simple to perform. They assess the aggregate force or pressure that respiratory muscles can generate against an occlusion at the mouth. PImax is an index of diaphragm strength, while PEmax measures the strength of abdominal and intercostal muscles. The most commonly reported method of measuring respiratory muscle force is that reported by Black and Hyatt. The equipment required is a pressure gauge or manometer that can be an electronic or a non-electronic handheld device or part of a more complex pulmonary function (PF) system. The technician must be a motivating coach and encourage the patient to give maximal efforts on a test that is very effort-dependent and may be uncomfortable. PEmax is measured at or near total lung capacity (TLC), and PImax is measured near residual volume (RV).

Some indications for measuring maximum respiratory pressures are:
• Assess and quantify the degree of respiratory muscular weakness that may occur with neuromuscular diseases (e.g., amyotrophic lateral sclerosis, myasthenia gravis, and polymyositis), obstructive lung disease causing hyperinflation (e.g., emphysema, chronic bronchitis, and cystic fibrosis), and conditions requiring chronic steroid use, conditions with chest deformities, and unexplained dyspnea.
• Abnormal diagnostic test results [e.g., decreased forced vital capacity (FVC), peak flow, maximal voluntary ventilation (MVV), or abnormal chest radiograph].
• The PEmax gives information about the potential for effective cough and ability for secretion clearance.
• Diagnosis and management of a patient with actual or suspected injury to the diaphragm or other respiratory muscles.
• Evaluate the effectiveness of therapy designed to improve respiratory muscle strength.

Bronchoscopy

A bronchoscopy is an examination of your airways with a long and flexible tube fitted with a camera and light called a bronchoscope.

This procedure may help your doctor diagnose your condition and prescribe a treatment. Sometimes biopsies (tissue samples) are taken to help diagnose your illness.

For more information on Bronchoscopy please visit the AHS website.

Make sure you have signed the consent form with your doctor.

Instructions for the procedure:

    • Do not have anything to eat or drink after midnight – the night before your procedure. (eg. you may eat at 5:00 pm May 7 if your procedure is on May 8.)
    • You must have transportation home after the procedure.
    • You will need to schedule a follow-up appointment with your respiratory specialist approximately 1 week after your procedure.

Sleep Medicine

If you have suspected sleep apnea you may require a home sleep study or level III sleep study done. The study will be performed by a sleep company, the results of the study will be forwarded to our clinic and Dr. Tourin will review the results with you at the follow-up appointment. 

A Level III Sleep Test is a portable sleep test performed in a patient’s home. This test is used to screen moderate uncomplicated sleep apnea but is not able to accurately diagnose other sleep disorders (in this case you may need further testing)

What is a Level III Sleep Test (Snoresat test)?

  • This is an overnight test that you are able to do in the comfort of your own home. The test monitors your breathing, oxygen levels, heart rate, snoring, and body position while you sleep.
  • When you go to sleep, you will be hook up to three sensors to your body for one full night. You will put a probe on your finger, a small microphone on your throat, and small tubing into your nostrils.
  • The monitor is in a medium-sized camera bag and weighs 1 kg (2 lb).