Respiratory – FAQ

A pulmonary function test (PFT) is a complete evaluation of the respiratory system and tests of pulmonary function. The primary purpose of pulmonary function testing is to identify the disease and the severity of pulmonary impairment.

It usually takes about 15 minutes to complete. But, depending on the patient and the test ordered, sometimes it takes more than 30 minutes.

Follow these instructions:

• No bronchodilator medication for four hours before the test.
• No smoking for four hours before the test.
• No heavy meals.
• Do not wear any tight clothing.
• No caffeine for four hours before the test (soda, coffee, tea…)

By measuring how much air you exhale, and how quickly you inhale. While you are sitting, you breathe into a mouthpiece that is connected to an instrument, called a spirometer, attached to a computer. A spirometer can evaluate a broad range of lung diseases.

They are sometimes done on healthy people as part of a routine physical. They are also routinely done in certain types of work environments (such as graphite factories and coal mines) to ensure employee health.

PFTs may be used to check lung function before surgery or other procedures in patients who have lung or heart problems, who are smokers, or who have other health conditions. Another use of PFTs is to assess treatment for, emphysema, and other chronic lung problems.

Pulmonary function testing is not an invasive procedure, it is safe and quick for most people. Talk with your therapist about any concerns you have.

You will be asked to loosen tight clothing, jewelry, or other things that may cause a problem with the procedure.

• If you wear dentures, you will need to wear them during the procedure.
• You will need to empty your bladder before the procedure.
• You will sit in a chair. A soft clip if needed will be put on your nose. This is so all of your breathing is done through your mouth, not your nose.
• You will be given a sterile mouthpiece that is attached to a spirometer.
• You will form a tight seal over the mouthpiece with your mouth. You will be instructed to inhale and exhale in different ways.
• You will be watched carefully during the procedure for dizziness, trouble breathing, or other problems.
• You may be given a bronchodilator after the tests. The tests will then be repeated several minutes later, after the bronchodilator has taken effect.

If you have a history of lung or breathing problems, you may be tired after the tests. You will be given a chance to rest afterwards. Your healthcare provider will talk with you about your test results. The ordering provider will the discuss the result in details and depending on the results he or she might put you on certain medication to manage or help your breath better.

A 24-hour blood pressure monitoring or ABPM uses a digital machine to take and record your blood pressure for 24 hours by inflating a cuff around your upper arm and then slowly releasing the pressure.

ABPM, Ambulatory Blood Pressure Monitors, allow a doctor to assess your blood pressure during your routine daily living, instead of when you are sitting nervously on the doctor’s examination table.

ABPM reports your blood pressures as they are obtained through a wide range of situations and activities — from running to catch a bus to sleeping. It is normal for a person’s blood pressure to fluctuate tremendously during the many activities a person typically performs in a day. So, unlike the blood pressure you get in the doctor’s office, the ABPM does not report merely a single value for systolic and diastolic blood that supposedly represents your official “blood pressure.” Instead, it reports an entire range of (often) widely variable values throughout the course of a day or longer.

ABPM has also been useful in situations in which it has been difficult to determine the effectiveness of an anti-hypertensive treatment regimen, or when a person is suspected to have abnormally wide fluctuations in blood pressure that make diagnosing and treating hypertension difficult.

ABPM testing can also help to predict the likelihood of cardiovascular (blood vessels in the heart) and cerebrovascular (blood vessels in the brain) disease linked to hypertension and organ damage.

Ambulatory BP monitoring may also be suitable in other situations, such as for:

• Pregnant women with hypertension
• Patients with “borderline” hypertension
• Difficulty controlling BP with medication
• BP changes due to other drugs
• Changes in prescription medications that may impact BP
• Fainting episodes or hypotension (low BP)

The technique most commonly used for evaluating the results of ABPM is to average a person’s systolic and diastolic blood pressures for a full 24 hour period, and also for the hours that the person is awake and asleep.

Hypertension is generally diagnosed if the average blood pressure exceeds one of the following values:

• 24 hour average: systolic blood pressure above 135 mmHg, OR diastolic blood pressure above 80 mmHg.
• Average for “awake” hours: systolic blood pressure above 140 mmHg, OR diastolic blood pressure above 90 mmHg.
• Average for “asleep” hours: systolic blood pressure above 124 mmHg, OR diastolic blood pressure above 75 mmHg.

A 24-hour blood pressure measurement is just the same as a normal blood pressure check: The machine is small enough to be worn on a belt on your waist while the cuff stays on your upper arm for the full 24 hours.

The machine then takes blood pressure readings at regular intervals throughout the day: usually, every 15-30 minutes during the daytime and 30-60 minutes at night. You will need to keep the monitor on through the night – you could put the machine under the pillow or on the bed while you sleep.

At the end of the 24 hours you can remove the machine and cuff and give it back to the hospital. The machine will have stored all your readings and these will then be analyzed.

To allow the machine to work properly, it is important to make sure that the tube to the machine is not twisted or bent. Also, just before the machine is about to take a reading, it will beep. When this happens you should:

• sit down, if possible 
• keep the cuff at the same level as your heart
• keep your arm steady.

Because the test is being carried out to find out what your normal daily blood pressure is, it is important to carry on with your normal routine and do all the things you would normally do. The only things you should avoid doing for the day are swimming and having a bath or shower.

A Holter Monitor is a type of ambulatory electrocardiography device, a battery-operated portable device that measures and records your heart’s activity continuously. It is the size of a small camera, and has wires with silver dollar-sized electrodes that attach to your skin.

ECG is the measurement of your heart’s activity in a given time (real time) while Holter Monitor is recording of the measurement of your heart’s activity continuously.

Sometimes the ECG cannot detect other heart conditions or events in a given time. Your provider will order s Holter Monitor for 24 hrs to record the measurement of your heart’s activity.
You may have this test to find out if you have a problem with your heart. Many heart problems can only be noticed when you are doing something. They may happen when you exercise, eat, or sleep. Or they may happen when you have a bowel movement or you feel stressed. Your Holter monitor will record the way your heart beats during all of these activities.

A monitor can help diagnose many heart conditions, including:
• Atrial fibrillation, a rapid heartbeat that can lead to stroke.
• Ventricular tachycardia , a fast heartbeat that starts in your heart’s lower chambers
• Other irregular heartbeats (your provider might call them “cardiac arrhythmias”), including signaling (conduction) disorders and slow heartbeat

A Holter monitor is painless. There are no risks. However, some people have mild skin irritation from the tape used to attach the electrodes to the chest.

Taking the monitor off isn’t a good option. You might miss an important heart event that could give your doctor key information about your health. If your doctor recommends this test for you, you need to keep the monitor on during the entire test period.
You will also need to write in your symptom diary and push the monitor’s event button if you feel symptoms of a heart problem. If you don’t, the monitor won’t provide useful information.

• Magnets, metal detectors, and high-voltage electrical wires
• Microwaves
• Electric razors and toothbrushes
• Smoking and tobacco use
• Certain medications

• Before the test, talk to your provider about all your health problems. Tell him or her about all the medicines and vitamins you take.
• Take a shower or bath before the pads are put onto your chest. You must not get the pads wet during the test.
• Wear a loose fitting shirt.
• Do not use creams, lotions or oils on your chest for at least 24 hours prior to the test.

• Areas of your chest may be shaved and cleaned.
• The electrode pads are attached to your chest with a paste or gel.
• Your therapist will show you how to wear or carry the monitor. For example, you might wear the monitor on a strap over your shoulder, hooked on a belt, or placed in a pocket. It does not weigh much.
• Your therapist may give you extra instructions on how to use the monitor at home

• You will go back to Cardio-Pulmonary Dept., the therapist will remove the monitor and the pads from you.
• You will give the dairy of event to the therapist.
• The monitor will be attached to a computer, download the results, enter the event from your dairy, analyze and the result to your provider.
• You can resume your daily activities
• Your provider’s office will contact you regarding the result and will discuss any plan needed if necessary.