Testing for COPD - Part II: Breathing Tests
This is Part II of my experience with diagnostic testing for Chronic Obstructive Pulmonary Disease. (Click here to read Part I.)
When I was being diagnosed with COPD, I took several breathing tests to help the diagnosis. My primary care doctor ordered a spirometry. Later, my pulmonologist ordered a CT (computer tomography) scan and a pulmonary function test, or PFT. The pulmonologist referred me to an asthma specialist who ordered a methacholine test. My latest test was the six minute walking test.
I took the spirometry test in my primary care doctor's office. This test was like a video game for us mouth breathers.
There was a computer with a video screen hooked up to a breathing apparatus. The video screen display was of a cartoon tree covered in leaves. I sat in a chair and blew through a little tube and the more I blew the more leaves fell off the tree. The goal was to make the tree look like fall had hit early and thoroughly. In each test the computer calculated how much air I could breathe in and out in a given amount of time, as well as how quickly I could exhale. The test was kind of fun but I never got naked trees.
This test is more comprehensive than the spirometry and given by a pulmonary specialist. I went to a hospital for this test where I sat in a clear plastic booth with a clip on my nose to stop me from breathing through it, and a breathing tube in my mouth. Not comfortable. The nice specialist explained to me how the test would go.
Once the test started she morphed into a platoon sergeant in boot camp, commanding me to breathe longer, breathe more, keep breathing when I thought I couldn't anymore, and do better over and over. Which, yes, was really her job.
She was fantastic at it.
I wondered when she'd shave my head and give me my army uniform, she was that tough. It was, by far, the most painful test and I'm pretty sure I flunked.
This test is to determine an asthma diagnosis. The worst part about it was not being able to drink coffee or eat chocolate on the day of the test, so I was kind of (okay, very) crabby. The technician gave this test at a hospital.
This specialist was very kind and gentle and I kind of fell in love with him after the wrath of the “platoon sergeant.”
He had five doses of a solution with increasing amounts of methacholine in them, which causes the airway to contract. I breathed in the first one through a nebulizer, then did a short spirometry test to gauge the effects of the histamine on my breathing. I used a Xopenex rescue inhaler to calm my airways back to normal before I took the next, higher, dose of methacholine. In general, the test stops once lung function drops by 20%. This drop in function is indicative of asthma. By the time I got to the third dose my functioning had dropped down by almost 40%.
Yep, I had severe asthma. Somehow, I was not very surprised.
Six minute walking test
I asked my primary care physician if we could evaluate my need for oxygen and she agreed. Her nurse administered the six minute walking test, which is exactly what it sounds like. Simple.
The nurse applied a pulse oximeter on my finger to measure any drop in the oxygen level in my blood during the exercise. This would indicate the need for an emergency oxygen prescription. Then, with my walker, we started off down the hallway. I couldn't really talk and the walls were all white so it was kind of boring. Maybe next time I can put a racing game on my Kindle and hold it in front of me for motivation.
Hopefully, this helps explain the tests for anyone who may be currently going through them. Good luck and keep breathing!
Do you have an exacerbation toolkit?