Ch. 9

Question 1

What are specialized testing?

Answer 1

Standard tests performed under special conditions to evaluate a response to a condition or medication.

Question 2

Specialized testing are used in pts who have:

Answer 2

• A normal PFT but still have respiratory symptoms
• uncertain results of bronchodilator testing
• used to identify and characterize hyper-responsiveness in airways or (AHR).
• asses changes in hyper activity or to assess severity if symptoms
• for those at risk of environmental or occupational exposure to antigens and toxins

Question 3

Bronchial challenge?

Answer 3

• Used to identify and characterize hyper responsiveness in airways
the less gas it takes to evoke a negative response the more hyperactive the airway is

Question 4

Direct stimulus:

Answer 4

• methcholine
• histamine
• prostaglandins
• leukotrienes
works directly on parasympathetic muscle to cause bronchoconstriction

Question 5

Indirect stimulus:

Answer 5

• mannitol
• adenosine
• exercise
• EVH
• beta blockers
• hypertonic saline
indirectly stimulate bronchoconstriction via intermediary cells.

Question 6

Methcholine & histamine tests chemicals that _______ pts response to ________.

Answer 6

Increase ; bronchial smooth muscle

Question 7

Eucapnic Voluntary hyperventilation

Answer 7

Uses cold air or room temp gases and causes heat and water loss form airway.

Question 8

Metacholine challenge

Answer 8

• The lower dose needed to illicit a bronchospasm the more hyper responsive the airway.
• Stimulates parasympathetic response

Question 9

What is the metacholine challenge used for?

Answer 9

Pt who cannot tolerate repeated spirometry testing

Question 10

When FEV1 is reduced by ______ it’s considered a what test?

Answer 10

Positive
AKA PC20 provocative concentration

Question 11

Metacholine test is considered _______ if dose of MC reaches ______ with 20% reduction in FEV1

Answer 11

Negative ; 16mg/dL

Question 12

______ pts will experience a change in airway w/inc concentrations

Answer 12

ALL

Question 13

The lowest dose needed to stimulate a response the more ______ the pt is?

Answer 13

Hyperresponsive

Question 14

For testing the pt must be _______?

Answer 14

Asymptomatic

Question 15

How long do you withhold antihistamines?

Answer 15

48hrs

Question 16

The delivered dose of Metacholine is standardized by using a fixed number of of _______ breaths for each dose.

Answer 16

5

Question 17

What are the 2 types of test we use?

Answer 17

• 5 breath dosimeter (most common)
• 2 min tidal breathing method

Question 18

What is the highest dose for both of the tests?

Answer 18

16mg/dL
Range 0.016-16mg-dL

Question 19

5 breath dosimeter test

Answer 19

• Dosing starts at 0.016 and is increased x4 for each step until you reach max dose of 16 mg/mL.
• Can be prepared in advance and stand in fridge (must be room temp at time of use)
• delivers a constant volume of drug with a fixed volume of aerosol on each breath

Question 20

What does a patient do during the five breath dosimeter test?

Answer 20

• Patient takes 5 breaths of 1st concentration
• spirometry is repeated after each dose
• Test is repeated until FEV1 decreases 20% or until the max concentration of metacholine is reached

Question 21

If at any time during the 5 breath dosimeter test if the FEV1 decreases greater than or equal to 20% test is _______?

Answer 21

Complete

Question 22

After the 5 breath dosimeter test a _____ is given to reverse bronchospasm.

Answer 22

Bronchodilator

Question 23

After the 5 breath dosimeter test spirometry is repeated after ______ min?

Answer 23

10

Question 24

2 minute tidal volume breathing test

Answer 24

• duration is 2 min
• dosage starts at 0.031 mg/mL and inc x 2 for each step up to max dose of 16mg/mL
• can be prepared ahead of time and refrigerated but must be given at room temp
• a filter is used on the expiratory side to prevent medical lien release into room
• bronchodilator is given to reverse bronchospasm

Question 25

If a ________ of 20% in the FEV1 occurs after first dose report PC2O dose (less than the lowest concentration given)

Answer 25

Decrease

Question 26

If there is _______after last dose report PC20 greater than 16 mg/mL (greater than the highest max dose 16 mg/mL

Answer 26

No decrease

Question 27

A decrease FEV1 of 20% (PC20) at low doses of metacholine (<1 mg/mL) means there’s a high probability of _______?

Answer 27

Asthma (negative test)

Question 28

The histamine challenge stimulates________ directly and uses ________ histamine?

Answer 28

Bronchoconstriction; aerosolized histamine

Question 29

For the histamine challenge as long as the patient does not have a decrease in _________of_________ with dilutent test continues?

Answer 29

FEV1; >20%

Question 30

How does the histamine challenge work?

Answer 30

Pt breaths in 5 breaths of 1st concentration

Question 31

Histamine challenge
Test begins at ________ doubled until reach a max dose of ________?

Answer 31

0.03 mg/mL; 10mg/mL

Question 32

What are some common side effects of histamine?

Answer 32

• flushing
• headaches
• sleepiness

Question 33

Bronchospasm can be ________ by antihistamines?

Answer 33

Blocked

Question 34

Withhold antihistamines ________ before test?

Answer 34

48 hrs

Question 35

Can also be__________ by bronchodilators?

Answer 35

Partially blocked

Question 36

Peak action of histamine is in ________ same as metacholine challenge?

Answer 36

30sec-2min

Question 37

Exercise challenge:
_______ usually occurs during or immediately after vigorous exercise.

Answer 37

Bronchospasm

Question 38

Exercise challenge:
Bronchospasm is usually due to _____ & _______ loss in airways due to inc ventilation.

Answer 38

Heat; water

Question 39

Exercise challenge:
Commonly used in patients with ________?

Answer 39

exercise induced asthma (EIA)