Routine screening test in adults | Exclusion (if test is normal) |
Air trapping measured by body plethysmography | Bronchiolitis obliterans |
Carbon monoxide diffusion capacity | Emphysema or parenchymal lung disease |
Chest HRCT scan | Parenchymal lung disease |
Bronchiolitis obliterans | |
Bronchiectasis | |
Congestive heart failure | |
D-dimer | Recurrent pulmonary embolism |
Suspected alternative or additional diagnoses in adults | Diagnostic test |
Intrabronchial obstruction | Bronchoscopy |
Vocal cord dysfunction | Laryngoscopy during attack |
Dysfunctional breathing/panic attacks | Blood gases during attack |
Hyperventilation provocation test | |
Recurrent microaspiration | Proximal oesophageal pH measurement |
Bile salts in bronchoalveolar lavage fluid | |
Cystic fibrosis (CF) | Sweat test |
Allergic bronchopulmonary aspergillosis (ABPA) | Aspergillus IgE/precipitins/sputum culture |
Emphysema | High resolution CT scan |
Hypersensitivity pneumonitis | |
Bronchiectasis (including ABPA, CF) | |
Recurrent pulmonary embolism | CT pulmonary angiography |
Pulmonay arterial hypertension | |
Bronchiolitis | Transbronchial or thoracoscopic lung biopsy |
Sarcoidosis | |
Systemic | |
Churg–Strauss syndrome | Biopsy of affected organ(s) |
Antineutrophilic cytoplasmic antibodies |
Suspected alternative or additional diagnoses in children | Diagnostic test |
Structural abnormalities (tracheobronchial malacia, vascular compression/rings, tracheal stenosis/webs, cystic lesions/masses, tumours/lymphadenopathy/cardiomegaly) | Fibreoptic bronchoscopy |
Thorax CT scan | |
Intrabronchial obstruction (eg, inhaled foreign body) | Rigid bronchoscopy |
Vocal cord dysfunction | History, direct observation |
Dysfunctional breathing/panic attacks | History, direct observation |
Gastro-oesophageal reflux with/without recurrent microaspiration | Proximal oesophageal pH measurement |
Bile salts in bronchoalveolar lavage fluid | |
Cystic fibrosis (CF) | Sweat test |
Immune abnormalities | Serum immunoglobulins including IgA, G, M and IgG subclasses and vaccine antibody responses (Haemophilus, tetanus and Pneumococcus) |
Bronchiectasis (including CF, primary ciliary dyskinesia) | High resolution CT scan |
Bronchopulmonary dysplasia | History of prematurity |
Bronchiolitis obliterans | High resolution CT scan |
Lung biopsy |