Common Tests A Pulmonologist Recommends And Why?

Pulmonologists are doctors who deal with lungs and related diseases. Common diseases associated with lungs are Tuberculosis, Bronchial Asthma, Acute Bronchitis, COPD, pneumonia, lung cancer, pleural effusion, Pneumothorax, bronchiectasis, Pulmonary Fibrosis (Interstitial Lung Disease – ILD) etc.

Common respiratory symptoms are cough, fever, expectoration, breathlessness, wheezing, chest pain, weight loss, hemoptysis (blood in sputum) etc. So when any patient visits a Pulmonologist for any of the above symptoms, a Pulmonologist will examine the Respiratory system and recommend few reports or tests to prove his/her diagnosis.

[Also Read: Causes of dull chest pain]

Pulmonologists commonly recommend Blood investigations, Radiological investigations, sputum reports, Bronchoscopy and Pulmonary Function Test (PFT).

Various Tests Recommended By A Pulmonologists And Why?

Following are some common tests recommended by pulmonologists. Let’s talk about these tests in detail and why they are needed.

Blood Investigations

CBC (complete blood count)

This is a basic blood report which gives information about Hemoglobin level, Total WBC (white blood cells) counts, Platelet count. If Hemoglobin is low, patients can have breathlessness. If a patient is having pneumonia or tuberculosis then CBC will show high (Elevated) WBC count. If a patient is having low platelets then risk of Hemoptysis is high. If platelets are high then tuberculosis infection is more likely. So by looking at CBC reports we can get ideas about many Respiratory diseases.

ESR (erythrocyte-sedimentation-rate)

This is a marker of inflammation, specifically chronic infections like Tuberculosis. So if someone is having high ESR, chances of tubercular infection is more likely.

CRP (C Reactive Protein)

This is again a marker of inflammation specifically acute infection. It is elevated in acute respiratory tract infections like pneumonia, ARDS (Acute Respiratory Distress Syndrome).

TB Gold Test

It is recommended by WHO for identification of latent Tuberculosis. It is particularly useful in pediatric and immunocompromised patients.

Radiological Investigations

Chest x ray PA View

This is the commonest form of chest x ray recommended by pulmonologists. This kind of X-ray is ideal to visualize lungs and it’s structures. Chest X ray is a basic investigation for all Respiratory diseases like tuberculosis, pneumonia, lung cancer, pleural effusion, Pneumothorax etc. If a patient has been coughing for more than 2 weeks (chronic cough), unexplained weight loss, fever, decreased appetite then chest x ray should be done first.

CT Thorax

It is an advanced level of radiological investigation. Basically it is a 3D image of lungs. Chest X ray gives 2D view of lungs while CT gives 3D view. So CT thorax is recommended when chest x ray is inconclusive in diseases like Lung Cancer, pneumonia, Mediastinal Lymphadenopathy, Pulmonary Fibrosis etc. CT Pulmonary Angiography is a special type of CT scan in which Blood vessels of lungs are visualized. This kind of special CT scan is needed for Pulmonary embolism, Pulmonary infarction and Pulmonary hypertension.

Ultrasound Thorax

It is a simple sonography of lungs. Usually the lung looks black on ultrasound but when there is pleural effusion (abnormal collection of fluid around lungs between two pleural layers), ultrasound is best for not only diagnosis but also for aspiration of pleural fluid. So ultrasound thorax is best for pleural effusion.

PET Scan

It is the nuclear scan needed to identify distant metastasis in case of lung cancer.

Sputum Report

Sputum For AFB (Acid Fast Bacilli)

This is a basic test for Pulmonary tuberculosis. Any patient having chronic cough, expectoration, weight loss, fever, decreased appetite etc should be tested for Sputum AFB along with chest x ray PA view.

Sputum Culture And Sensitivity (C S)

This is recommended in case of pneumonia (lung infection). Culture will isolate the causative organism and sensitivity report will guide about effective antibiotic treatment.

Pulmonary Function Test (PFT)

1. Spirometry

   It is the most basic amongst other PFTs. In this test, a patient is made to inhale and exhale in a tube which is connected to the computer. Based on the patient’s respiratory efforts, the computer will generate a spirometry report which gives ideas about the patient’s lung functions. It is a gold standard test for Asthma and Bronchitis patients. Patient should undergo Spirometry if he/she is having breathlessness on exertion, wheezing, chronic dry cough, allergies etc.

2. Other PFTs

   Lung Capacities, DLCO (Diffusing Capacity of Carbon Monoxide) etc are advanced PFTs which are useful in Pulmonary Fibrosis patients.

Bronchoscopy –It is not actually a test but it is a procedure. It is an endoscopic visualization of airways. It is recommended in pneumonia, lung abscess, lung cancer, ARDS etc. Samples like BAL (bronco alveolar lavage), Biopsy, Brush Cytology etc are obtained via bronchoscopy for the diagnosis of above mentioned diseases.

Allergy Testing –Some pulmonologists also practice allergy. And they usually recommend AEC (absolute eosinophil count), Serum IgE level, Skin Prick Test (SPT) etc. These tests are recommended mostly in severe allergic Asthma patients who are not controlled with routine asthma drugs.

Special Tests which are significant in current era

1. Swine Flu Testing

When you have symptoms like sudden onset high grade fever, sore throat, cough, breathlessness during swine flu epidemic season, your pulmonologist recommends throat swab for swine flu testing.

2. CoronaVirus Testing

During the last couple of months the entire world is threatened by a new type of virus, CoronaVirus. This also affects the respiratory system and causes symptoms like fever, cough, sore throat, pneumonia, ARDS etc. Two nasal swabs and two pharyngeal swabs are recommended for CoronaVirus infection.

Dr. Kaushal Bhavsar

Dr. Kaushal M Bhavsar pursued his MD in Pulmonology. He is an Assistant Professor in Pulmonary Medicine, GMERS Medical College, Ahmedabad.