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Saturday, May 25, 2013

Lab test for bronchospasm

I kid you not, folks, that there is a new lab test out that can test for bronchospasm.  We RTs have been hoping for something like this for years, because most of us realize within the first few months of doing this job that the term bronchospasm is loosely defined for the medical community. 

Bronchospasm is basically an umbrella term used when adventitious lung sounds are misinterpreted for sounds that indicate bronchospasm.  So patients with other ailments end up getting a bronchodilator when what they needed was something else. 

As respiratory therapists, we have been taught to break down lungsounds into three main categories:
  • The patient is wet:  The doctor should think diuretics
  • The patient has pneumonia: The doctor should think antibiotics
  • The patient has bronchospasm: The doctor should think bronchodilators
These are the three broad categories we RTs must consider when trying to understand and define a patients complaint.  The physiology of these three categories are often exclusive of each other.  However, most physicians and nurses either cannot differentiate one from the other, so they treat them all the same, and therefore all patients complaining of dyspnea get bronchodilators.  So much for the text book of medicine.  So much for science. 

Now what?  What is a respiratory therapist supposed to do when respiratory therapy is beyond the scope of a physician's knowledge and the physician is to much of a dunderhead to admit that his respiratory therapist knows more about it than he does?  The answer is to recommend to the physician a new test that accurately diagnoses bronchospasm.

Why not? There's BNP for heart failure.  There's procalcitonin for sepsis. There's perineal plastic panel for cancer.  There's the double standed dizziness titer for dizziness. Why not a test to diagnose bronchospasm.  And, believe it or not, there now is such a test that is now set to revolutionize how doctors treat and diagnose patients who present with dyspnea.

I present to you the double stranded bronchospasm titer. It's a simple lab test you can add to the venous blood draw the lab technician collects.  A simple gadget can be added to the ABG machine, and the blood can be run through the ABG machine (you can also use arterial blood).  Results are available as a percentage in a manner of minutes.  The results are as follows:
  • 0%  (If the patient is dyspneic, then the doctor is forced to think and consider something else.)
  • 25% (The patient is mildly dyspneic and may even appear to be in no distress)
  • 50% (The patient is probably all frogged up on the edge of the bed gasping for air)
  • 100% (well, here the patient would be dead)
If you have a certain degree of bronchospasm, then the doctor should order a bronchodilator. Or, if you have a protocol, you just give one and report the results to the physician.  If the results show 0% bronchospasm, then you know with 100% certainty all the bronchodilators in the world won't benefit your patient.  Yes, you will have proof that all those years you were right that 80% of the breathing treatments you did were a waste of time. 


Sara said...

Could you share more info abotu this lab test? I would love to be able to take this to the education coordinator in the dept (teaching hospital), to see if it's something feasible for us to request. We are a level 1 cardiac care center, so it would be great to be able to prove cardiac wheeze from bronchospasm.
Thanks! Sara

Rick Frea said...

I'm sorry, this lab test was a figment of my imagination... I should have been more clear on that.