What constitutes a respiratory workup?

From the Guidelines

A respiratory workup should include a comprehensive evaluation of a patient's respiratory system, starting with a medical history review, physical examination, pulmonary function tests (PFTs), and a chest X-ray, as recommended by the most recent guidelines 1. The workup typically includes:

• Medical history review
• Physical examination
• Pulmonary function tests (PFTs), including spirometry and lung volume measurements
• Chest X-ray
• Blood tests, such as arterial blood gas (ABG) analysis
• Sputum culture (if infection is suspected) Additional tests may be ordered based on initial findings, such as:
• CT scan of the chest
• Bronchoscopy
• Exercise stress test
• Sleep study (if sleep-related breathing disorders are suspected) The American College of Radiology recommends that a chest radiograph should generally be the initial imaging study in chronic dyspnea 1, and the American Thoracic Society suggests that spirometry should be part of a comprehensive occupational health program 1. The goal of a respiratory workup is to identify various respiratory conditions, such as asthma, COPD, pneumonia, or lung cancer, and to provide a complete picture of lung function, structure, and any underlying issues, ultimately leading to more effective treatment and management of respiratory conditions 1. It is essential to prioritize the most recent and highest-quality studies, such as those published in 2018 by the Journal of the American College of Radiology 1, when making decisions about respiratory workups.

From the Research

Components of a Respiratory Workup

A respiratory workup typically involves a combination of the following components:

• Patient history: gathering information about the patient's symptoms, medical history, and lifestyle to identify potential respiratory problems 2
• Physical examination: performing a physical examination of the patient to assess the respiratory system, including inspection, palpation, percussion, and auscultation 3
• Clinical 'red flags': evaluating clinical 'red flags' to reduce the risk of omitting serious illness 2
• Pulmonary function tests: assessing ventilatory function and gas exchange, including tests such as lung volume, vital capacity, FEV1.0, and arterial blood gas tensions 4
• Exercise tolerance: assessing exercise tolerance to evaluate the patient's ability to perform physical activity without experiencing respiratory distress 4

Assessment Techniques

Various assessment techniques are used in a respiratory workup, including:

• Inspection: visual examination of the patient's chest and respiratory system 3
• Palpation: physical examination of the patient's chest and respiratory system using touch 3
• Percussion: using sound waves to assess the patient's lungs and chest cavity 3
• Auscultation: listening to the patient's breath sounds using a stethoscope 3

Specialized Assessments

In certain situations, specialized assessments may be necessary, such as:

• Bedside assessment: assessing the respiratory system of a patient receiving mechanical ventilation 5
• Evaluation of airway responsiveness: assessing the patient's airway responsiveness to identify potential respiratory problems 4