Advances in the Diagnosis and Evaluation of Disabling Physical Health Conditions (2023) / Chapter Skim
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6 Techniques for Respiratory Disorders
6 Techniques for Respiratory Disorders
Pages 131-162
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From page 131... ...
Newer methods of diagnosis for respiratory diseases include advances in imaging techniques, less invasive approaches to the biopsy of respiratory structures, the use of serum or exhaled breath inflammation biomarkers in the early detection of airways disease, and the expanded use of genetic analysis in the diagnosis of some lung diseases. In addition, genetic analysis has also revolutionized the diagnosis and treatment of lung cancers.
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From page 132... ...
Following those descriptions, at the end of the chapter the committee emerging respiratory techniques that may become generally available in the next 5–10 years. BOX 6-1 Selected New or Improved Respiratory Diagnostic and Evaluative Techniques Since 1990 Assesses Anatomical or Physiologic Function High-Resolution Computed Tomography Cardiopulmonary Exercise Test Bronchoprovocation Test 6-Minute Walk Test Modified Medical Research Council Dyspnea Scale BODE Index Indirect or Potential Relevance to Physical Function Endobronchial Ultrasound Video-Assisted Thoracic Pleuroscopy Positron Emission Tomography Genetic Testing
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From page 133... ...
The clinical history and physical examination guide the selection of the appropriate pulmonary function tests, laboratory tests, imaging techniques, and biopsy procedures. Overview of Pulmonary Function Testing Pulmonary function testing (PFT)
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From page 134... ...
PFT is central to the diagnostic evaluation of any respiratory symptom, including shortness of breath, cough, or wheezing. These symptoms are also indicated to identify pulmonary impairment associated with, or resulting from, another recognized process, such as chest wall deformity, collagen vascular disorder, sickle cell disease, or neuromuscular disorder, or to seek evidence of a lung disease as the cause of another recognized process, such as pulmonary hypertension.
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From page 135... ...
These changes in the treatment of normative values may affect the sensitivity of pulmonary function tests for the identification of early or mild impairment, which is important in diagnosis of many respiratory diseases. It should have less effect on the assessment of disability due to advanced disease, however, since the SSA Listing of Impairments used absolute values of spirometric measures stratified by sex, height, and age above or below age 20 to define threshold values for disability and so are independent of reference values.
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From page 136... ...
CT can be used for virtual b ronchoscopy or angiography, but this has not become routine. CT is applied in combination with positron emission tomography mainly for staging lung cancer and other malignancies and in the differential diagnosis between benign and malignant lung lesions.
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From page 137... ...
Pertaining to interstitial lung disease, compared with conventional CT imaging, HRCT is more sensitive and specific in the evaluation of diffuse interstitial lung diseases For example, HRCT may provide sufficient characterization of findings to support a diagnosis of idiopathic pulmonary fibrosis (IPF) without the need for surgical biopsy and histopathologic evaluation.
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From page 138... ...
Although HRCT can characterize patterns of radio graphic abnormalities, e.g., in ILD, not all patterns are unique to specific clinical diagnoses. The integration of clinical history, imag ing, and lung function tests is generally needed to establish specific diagnoses of lung diseases.
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From page 139... ...
Among individuals with chronic obstructive lung disease, exercise limitation can result from the development of dynamic hyperinflation (a progressive rise in lung volumes due to incomplete exhalation as respiratory rate increases) , a mechanical consequence of airflow obstruc tion, during exercise, which reduces exercise breathing capacity compared to rest.
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From page 140... ...
(f) In terms of the limitations of the previous techniques: • Lung function tests performed at rest do not necessarily predict how a particular degree of impairment will affect the ability to perform activity.
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From page 141... ...
. Its diagnostic utility is dependent on an interpretation TABLE 6-1 Typical CPET Findings in Uncomplicated Respiratory Disease Variable Typical Pulmonary Outcome ∙ Peak VO2 (liters/minute)
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From page 142... ...
Bronchoprovocation testing is most commonly used to identify bronchial hyperreactivity in cases in which asthma is suspected but routine pulmonary function tests have not demonstrated airflow obstruction, which is intermittent. The test identifies bronchial hyperreactivity, which is typical of, but not unique to, asthma.
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From page 143... ...
(e) Access to bronchoprovocation testing may vary by medical facili ties, and it is not performed in all pulmonary function laboratories.
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From page 144... ...
These factors may limit the test's availability in pul monary function laboratories. Despite standardized protocols, there remains variability in the results of bronchoprovocation testing.
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From page 145... ...
. Compared with pulmonary function tests, functional performance tests such as the 6MWT capture the effects of secondary and coexisting conditions such as cardiovascular disease, frailty, obesity, deconditioning, and sarcopenia on the physical performance of individuals with primary respiratory disease.
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From page 146... ...
• Lung transplant assessment. For advanced respiratory diseases including PAH, COPD, IPF, and cystic fibrosis (CF)
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From page 147... ...
dyspnea scale has been widely used in respiratory diseases since first developed in the 1940s (Fletcher et al., 1959)
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From page 148... ...
. It corrolates with assessments of lung function impairment and of exercise impairment, and it is complementary to lung function in predicting disability due to lung disease (Bestall et al., 1999)
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From page 149... ...
BODE Index The overall burden of respiratory disease includes aggregate effects not only of impaired lung function, but also of symptoms, periodic exacerbations, and treatments. A number of multidimensional instruments have been developed for use in respiratory diseases, particularly in COPD (van Dijk et al., 2011; Oga et al., 2011)
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From page 150... ...
The BODE index combines measures reflecting lung function, exercise capacity, symptoms, and a systemic risk factor, so it is multi-dimensional.
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From page 151... ...
It requires separate performance of its component parts, which can limit its availability. Evidence that the BODE index is a significant reflection of disease severity is its ability to predict mor tality and other significant endpoints.
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From page 152... ...
Other modifications substitute the 6-minute walk test with another field test such as incremental shuttle walk test or with peak oxygen uptake from CPET, either of which are likely more rigorous measures of exercise capacity, or else with the 1-minute sit-to-stand test, which may be easier to perform in limited space. INDIRECT OR POTENTIAL RELEVANCE TO PHYSICAL FUNCTION A number of diagnostic procedures in respiratory medicine meet the first two inclusion criteria identified in Chapter 1 for this report -- that is, they are new or improved or have become generally available in the last 30 years -- but they do not meet the third criteria as they would generally not have a direct impact on re-assessment of disability.
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From page 153... ...
may vary based on geographic or practice patterns. Racial and ethnic disparities have been reported in the diagnosis and treatment of lung cancer, including the use of staging procedures (Lathan et al., 2006)
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From page 154... ...
• The biospy of peripheral lung tissue for diagnosis of interstitial lung disease is accomplished with a less extensive surgery with VATS than with thoracotomy. • The diagnosis of primary (mesothelioma)
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From page 155... ...
Currently close to half of all non-small-cell lung cancers can be identified as having a genetic basis that can be targeted by specific therapeutic agents. The identification of genes associated with specific non malignant respiratory diseases is also expanding.
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From page 156... ...
There is a growing number of other respiratory diseases for which specific mutations are known. For most of these, clinical diagnosis is still based first on findings related to the gene product or function, or phenotype, followed by targeted genetic testing to identify the specific mutations.
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From page 157... ...
Another potential role for this technique is the identification of small airways disease, such as bronchiolitis, which is often difficult to identify or quantify on spirometry or imaging but is an important cause of morbidity. The feasibility of oscillometry use in clinical practice has increased considerably in recent decades with the development of computers for signal processing and production of instruments by commercial vendors either as standalone products or integrated into suites of pulmonary function testing equipment.
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From page 158... ...
2021. Bias against complex lung cancer surgery.
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From page 159... ...
2004. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease.
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From page 160... ...
2020. Using the bode index and comorbidities to predict health utilization resources in chronic obstruc tive pulmonary disease.
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From page 161... ...
2014. An official systematic review of the European Respiratory Society/American Thoracic Society: Measurement proper ties of field walking tests in chronic respiratory disease.
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From page 162... ...
2015. A consensus document for the selection of lung transplant candi dates: 2014 - an update from the pulmonary transplantation council of the international society for heart and lung transplantation.
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