Clinical service overview
There are a number of different lung function tests that measure different aspects of lung function. Depending on the reason for referral and symptoms, more than one test may be undertaken.
Tests available include:
Spirometry – A measure of air movement in and out of the lungs. Spirometry assists with identifying ventilatory defects and can be performed before and after bronchodilator for assessment of reversibility of airflow obstruction.
TLCO – Transfer across the lung of carbon monoxide. This test is an assessment of gas exchange / alveolar membrane integrity.
Lung Volumes (plethysmography) – Measures lung size (eg TLC, FRC, RV). Lung volumes are useful for detecting restrictive and mixed ventilatory defects.
Bronchial Provocation Tests – May assist with diagnosis of asthma or assessment of effectiveness of asthma treatment.
- Mannitol Challenge: is bronchial provocation test of choice for the vast majority of cases.
- Eucapnic Voluntary Hyperventilation Challenge: primarily used for high level athletes where exercise induced bronchoconstriction is suspected.
Fraction of exhaled Nitric Oxide (FeNO) – May be useful in detecting current airway inflammation in those with eosinophilic asthma.
Cardiopulmonary Exercise Testing (stage 1) – Includes VO2, work, ventilation and heart rate. This is useful for patients with unexplained dyspnoea after other avenues to explain dyspnoea (cardiac / resting respiratory function) have been explored. Referrals for cardiopulmonary exercise tests are accepted from specialist physicians only. GPs: please contact the laboratory if a CPET is required.
Hypoxic Altitude Simulation Test – Assessment of oxygen saturation at simulated altitude (equivalent to maximum cabin altitude of commercial aircraft). This is useful for patients with respiratory impairment who wish to fly. Note: the outcome of this test should not be used alone to determine fitness to fly.
Maximal respiratory pressures – Provides an indication of global respiratory muscle strength (inspiratory & expiratory).
Relative Contraindications for Lung Function Tests
Most lung function tests require the patient to sit unaided and to follow specific instructions in the performance of breathing manoeuvres requiring maximal effort.
- Patients with poor cognitive function may have difficulties performing tests
- Patients with limited English language skills may require an interpreter – please document on referral if an interpreter will be required
There are few absolute contraindications for lung function tests. We may choose to delay or modify tests where there is an increased risk of an adverse event, or results may be impacted by pain/discomfort.
- Acute myocardial infarction in previous week
- Systemic hypotension or severe hypertension
- Significant atrial/ventricular arrhythmia
- Non-compressed heart failure
- Uncontrolled pulmonary hypertension
- Acute cor pulmonale
- Clinically unstable pulmonary embolism
- History of syncope associated with forced expiration/cough
- Cerebral aneurysm
- Brain surgery in previous 4 weeks
- Recent concussions with continuing symptoms
- Eye surgery in previous week
- Sinus surgery or middle ear surgery or infection in previous week
- Current pneumothorax
- Thoracic surgery in previous 4 weeks
- Abdominal surgery in previous 4 weeks
- Late-term pregnancy
- Current haemoptysis
Tests will be delayed where patients have communicable diseases such as:
- Open pulmonary TB (on active treatment and 3 negative AFB in sputum)
- Pertussis (>1 week antibiotic therapy)
- Gastroenteritis (> 48 hours after last symptoms)
Some tests require minimum levels of lung function for test to be performed:
- Vital capacity of at least 1.20L required for TLCO
- Baseline FEV1 >70% predicted or 1.5L AND good quality baseline spirometry for bronchial provocation tests
Please contact the Lung Function Laboratory on (03) 9076 3476 to discuss potential contraindications and/or document clearly on referral.
Children under 18 years of age are not seen at the Alfred
Refer your patient
Fax referral to us
We accept GP and specialist referrals to this service.
All referrals are triaged by the service according to clinical urgency. Patients requiring immediate assessment should be sent to the Emergency & Trauma Centre.
To refer your patient, complete and fax a referral to us. For urgent referrals, also contact the service Registrar to discuss the case.
To ensure appropriate and timely triage, include all demographic and clinical details as well as relevant investigation results.
If you are concerned about any delay of the appointment or if there is any deterioration in your patient’s condition, contact the service Registrar on call on (03) 9076 2000.
- Referral enquiries (03) 9076 3476
- Referral fax (03) 9076 3434
|Monday||The Alfred||8.30am - 4.30pm|
|Tuesday||The Alfred||8.30am - 4.30pm|
|Wednesday||The Alfred||8.30am - 4.30pm|
|Thursday||The Alfred||8.30am - 4.30pm|
|Friday||The Alfred||8.30am - 4.30pm|
On the doctor’s behalf, Alfred Health can bulk bill the cost of the consultation for some services through Medicare. This means there is no out of pocket expense to the patient.
MBS-billed services require a current referral. Provide your patient with a 12 month referral to see the specialist of your choice at the requested clinic.
Referrals must be addressed to a named specialist or the Head of service, listed at the top of this page. Clinic consultants are listed on every clinic page.
Note that from time to time, your patient may be seen by another specialist in the clinic, in order to expedite their treatment.