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Dr. Ragheb Assaly
COUGHING, WHEEZING, AND SHORTNESS OF BREATH are concerning symptoms, but ones with a multitude of potential causes. “These are symptoms that no one should ignore, particularly if they are prolonged,” said Dr. Ragheb Assaly, a pulmonary medicine specialist with The University of Toledo Physicians Group. “But in order to effectively manage or treat them, we need to know what’s causing them.”
The gold standard for diagnosing—or ruling out—some serious respiratory diseases such as COPD is the pulmonary function test. Pulmonary function testing is a non-invasive procedure that shows how well a patient’s lungs are working.
Administered by respiratory-therapy- trained technicians, the test can measure lung volume, assess how well a person’s lungs are absorbing oxygen and releasing carbon dioxide, and track how much air a person is breathing in and out.
The results of those tests allow physicians to diagnose and track the progression of conditions including chronic obstructive pulmonary disease, commonly known as COPD; asthma; and fibrosis, or scarring of the lungs. “While asthma can be diagnosed by a regular clinical exam, a pulmonary function test is required for making a definitive diagnosis of COPD. In a patient who is considering surgery to remove cancer, we can make calculations to project their remaining lung function after the procedure,” Assaly said. “We also can rule out respiratory disease. For example, someone’s shortness of breath might be less about their lung health and more about a cardiovascular problem. It’s a very useful test.”
UToledo Physicians Group offers pulmonary function testing at two locations, inside The University of Toledo Medical Center at 3000 Arlington Avenue, and at the UToledo Comprehensive Medical Practice at 2100 W. Central Ave.
A more involved but similarly non-invasive procedure called a cardiopulmonary exercise test also can be used to evaluate on a breathby- breath basis how well a person’s heart and lungs work together under the stress of exercise. That, Assaly said, can help clinicians determine how well someone is likely to tolerate a major surgery or to help identify conditions of lung disease affecting heart function.
Sometimes pulmonary function testing is equally useful for telling a patient what they don’t have. While COPD is a common condition, Assaly sometimes sees patients who believe they have the long-term, progressive disease but have never had a pulmonary function test. “I have told multiple patients they don’t actually have COPD after testing. That can change how their symptoms are treated and even how much they’re paying for life insurance,” he said. “It’s essential that these tests are performed.”
For those who do have COPD, treatments are available. Patients with emphysema, for example, may be candidates for a procedure called bronchoscopic lung volume reduction. UTMC was the first hospital in Northwest Ohio to offer the minimally invasive procedure, which uses small, one-way valves to keep air out of the lung’s most damaged parts while allowing healthier lung regions to function more normally.
Referrals are required for pulmonary function testing through UToledo Physicians, but Assaly said it’s important that patients know about the test so they can advocate for their own health. “Pulmonary function testing is often underused by primary care physicians. We want patients to know about the benefits of this so they can discuss it with their own primary care doctor, especially if they have risk factors for chronic lung disease such as a history of smoking, asthma, or exposure to lung irritants from industrial or farm work. Long-term asthma increases your risk of COPD. About 15% of smokers will develop it, and it’s not uncommon to see grain workers with no history of smoking develop COPD,” Assaly said. “That’s why we want to educate patients about the benefit of testing.”
Tyrel Linkhorn is a communications specialist at The University of Toledo. ✲
