Patient Services
The Institute For Better Breathing has the collective experience, the staff, and the modern equipment to test and diagnose pulmonary dysfunction, allergies, sleep apnea, snoring and nasal obstructions. In particular, The Institute has special equipment for in office fiberoptic laryngoscopy and somnoplasty. Additionally, The Institute has special equipment for diagnosis and treatment of osteoporosis. The following sections summarize major tests the physicians at The Institute For Better Breathing perform at their Burbank and Glendale, California facilities:
Allergy Testing
Doctors at the institute use skin tests to determine whether a patient has IgE antibodies in the skin that react to a specific allergen. The doctor uses diluted extracts from allergens such as dust mites, pollens, or molds commonly found in our local area. The extract of each kind of allergen is injected under the patient's skin or is applied to a tiny scratch or puncture made on the patient's arm or back. With a positive reaction a small, raised, reddened area (called a wheal) with a surrounding flush (called a flare) appears at the test site. There are also diagnostic tests that use a blood sample from the patient to detect levels of IgE antibodies to a particular allergen. One such blood test is called the RAST (radioallergosorbent test), which can be performed when eczema is present or if a patient has taken medications that interfere with skin testing.
Chest X-Ray
The physician uses the chest x-ray to reveal the structure of the chest and lung areas. This procedure may expose a large number of pulmonary diseases such as fibrosis and cancer as well as infections, pneumonia and extra fluid accumulations. The procedure is common and painless. The patient stands in front of the machine and holds his breath for a moment while the x-ray beam exposes the film. The photograph is developed and analyzed immediately.
CT Scan
A CT scan (computed tomography) of the chest uses x-rays to scan the chest from many angles. The detected information is analyzed by the computer. The computer generates an image of the area of the chest being scanned and displays the image on a computer video monitor. The images can also be reproduced as photographs. You will lie flat on a table that is guided into the CT scanner. The scanner emits x-rays from a complete circle around you. This non-invasive procedure is used to examine the structures inside the chest. Common indications for thoracic CT include chest injury, a suspected tumor, fibrosis or to search for bleeding or fluid collections in the lungs and adjacent areas.
Laryngoscopy
This is an optical instrument that assists the doctor during the examination of the larynx and vocal cords. This device has a flexible fiber optic cable that the doctor passes through the nose and the back of the throat until he sees the vocal folds. Because of the flexibility of the scope, the patient does not gag and is comfortable. With this device, the doctor can examine the larynx during normal speech and evaluate for gastric reflux, hoarseness and chronic cough.
Somnoplasty
The doctor performs somnoplasty to treat upper-airway obstructions. The doctor uses local anesthesia and the procedure is essentially painless. Somnolasty uses controlled, low-power microwave energy to create submucosal lesions. Over a period of 6 to 8 weeks, the lesions are naturally reabsorbed, reducing tissue volume and stiffening the remaining tissue in the desired area. Somnoplasty is a safer, less invasive solution for the treatment of upper-airway disorders than traditional surgical therapies. The procedure takes less than 2 minutes per turbinate. Somnoplasty reduces surgical risks without postoperative pain and moreover is office-based. To avoid traditional surgical pain, patients with various nasal conditions resulting from enlarged turbinates often endure prolonged use of intranasal sprays and systemic medications, which have minimum long term effectiveness and moreover carry the risk ofharmful side effects. Somnoplasty is proven effective for the following conditions: obstructive sleep apnea, habitual snoring, certain causes of cough and chronic nasal obstruction. Reducing nasal obstruction in the setting of chronic CPAP use can dramatically improve comfort and tolerability by reducing the pressure settings needed.
Bronchoscopy
Fiberoptic bronchoscopy examines the main airways for the presence of cancer or a foreign body. In this hospital procedure, the doctor suppresses the patient's gag reflex by spraying anesthetic into the throat. After light sedation, the doctor inserts the fiberoptic bronchoscope into either the nose or the mouth and passes it down the throat into the trachea and then into each lung. There are no pain fibers in the tracheobronchial tree, so the procedure is painless. Tissue for diagnosis can be obtained either by brushing, washing or biopsy.
Pulmonary Function Test
Spirometry
Spirometry measures the amount of air entering and leaving the lungs. The technician performs this simple test using a computerized instrument. This machine measures airflow that passes through the machine. The patient inhales deeply and then completely exhales through the machine. This is a valuable screening test that can identify obstructive diseases (asthma, emphysema) or restrictive diseases (fibrosis).
Peak Flow Rate
The spirometer also measures peak expiratory flow rate (PEFR). The doctor compares these readings with readings the patient obtains at home with their own portable peak flow meter.
Postbronchodilator Spirometry
If the doctor suspects an obstruction, he may repeat spirometry after the administration of a bronchodilator. This procedure provides some information on the potential responsiveness of the airways to medication as can be seen in asthma.
Lung Volume
Lung volumes are measured by a gas dilution method using either nitrogen or helium. The most important measurements are residual volume (RV) and total lung capacity (TLC). A high total lung capacity demonstrates hyperinflation, which is is consistent with emphysema. A low total lung capacity suggests restrictive disease and is consistant with fibrosis among other problems. Increased residual volume indicates air trapping. These tests are very important in understanding the individual patient's problem and point the way to optimal therapy.
Diffusion Capacity
Diffusion capacity is a measurement of the efficiency of gas transfer from the air to the blood. The patient inhales a very small amount of carbon monoxide that is absorbed into the blood. A reduced diffusion capacity is consistent with emphysema, although it occurs in other lung diseases as well. It is important in predicting the need for supplemental oxygen.
Exercise Testing and Oximetry
In exercise testing, the physician connects the patient to an oxygen sensor called an oximeter. The oximeter measures the amount of oxygen that the lungs are transferring into the blood. Exercise oximetry or pulmonary stress testing is useful to judge exercise tolerance, abnormal breathing patterns and possibly the need for supplemental oxygen.
PET Scan
PET scanning or Positron Emission Tomography, is a procedure that produces a 3D image indicating where the body is using oxygen to burn glucose. In PET, the physician injects a small amount of a tagged sugar molecule into the patient and places the patient in the PET scanner. The PET scanner consists of thousands of small radiation detectors that measure the radiation that is being emitted by the sugar molecule within the patient. Thus, the PET scanner makes 3D images that show where the tagged sugar molecule went in the body. A lesion that is actively using this sugar molecule more than a surrounding area can point to inflammatory or malignant change. This can guide further diagnostic studies as well as point to prognosis.
Thoracentesis
The doctor performs this procedure to drain fluid from around the lung for therapeutic purposes or to obtain a sample of this fluid for analysis. The doctor locates the pleural fluid by ultrasound or physical examination. The patient sits at a table, leaning against it with his arms resting on the tabletop. After administering an anesthetic, a small needle is advanced into the space around the lung, and then the fluid is drained.
Bone Density
The Institute For Better Breathing uses the Lunar Bone Densitometer, the state-of-the-art instrument to detect osteoporosis. The system provides for a comfortable, safe, and accurate examination. It typically takes only a few minutes of resting, fully dressed, on the densitometer. The test results are available immediately.
The machine measures bone density over the spine and hips as these sites are most at risk for fracture. With this test, the doctors can detect osteoporosis before a fracture occurs; predict your chances of fracturing in the future, determine your rate of bone loss and/or monitor the effects of treatment if the test is conducted at intervals of a year or more. Bone loss is exceptionally common in patients with various forms of lung disease.