CHAPTER – 9: CLINICAL LABORATORY

TESTS

Points to be covered in this topic

9.1 CLINICAL LABORATORY TESTS
• 9.1.1 Introduction

• 9.1.2 Importance of clinical laboratory tests

9.2 HAEMATOLOGICAL
• 9.2.1 Blood

• 9.2.2 Common haematology tests for blood

9.3 LIVER FUNCTION TEST

• 9.3.1 Liver

• 9.3.2 Major function of liver

• 9.3.3 Classification of liver function tests

9.4 RENAL FUNCTION TEST

• 9.4.1 Function of kidney

• 9.4.2 Renal Function test (kidney function test)

9.5 THYROID FUNCTION TESTS (TFTs)

• 9.5.1 Introduction

• 9.5.2 Thyroid function tests

9.6 TESTS ASSOCIATED WITH CARDIAC DISORDERS

• 9.6.1 Common tests to diagnose heart conditions

9.7 FLUID AND ELECTROLYTE BALANCE

 • 9.7.1 Fluids
• 9.7.2 Electrolyte

9.8 PULMONARY FUNCTION TEST

• 9.8.1 Introduction

• 9.8.2 Types of Pulmonary Function Tests

9.1 CLINICAL LABORATORY TESTS

9.1.1 INTRODUCTION
• The laboratory is an important part of medical

diagnostic procedures, adding objective

information to the more subjective history
and physical examination of the patient.
• Clinical laboratory studies have immeasurably advanced the medical

diagnostic process.
• Clinical laboratory test results are very important parameters in the

diagnosis, monitoring, and screening of disease.

• Blood and urine are commonly used as body fluids for analysis.

9.1.2 IMPORTANCE OF CLINICAL LABORATORY TESTS

The laboratory test data is useful to the healthcare team for the following purposes:
• Understanding patient his disease state: Pharmacists provide better services

as drug information specialists and consultants.

• Diagnosis of disease: The presence of certain abnormal constituents or an

abnormal amount or count of certain physiology value is indicative of the

disease state of organ or system.
 • Therapeutic management decision: Laboratory test results can be useful in
setting therapeutic goals, thereby deciding appropriate therapy and
therapeutic management decisions.
• Drug therapy monitoring: To support clinical assessment, laboratory test
results shall be required in this monitoring process.
• Communication with other members of healthcare team: The knowledge and
expertise of pharmacist in clinical laboratory test results and their
interpretation shall make him competent to actively participate in patient care
along with other members of healthcare team.

9.2 HAEMATOLOGICAL
• Haematology is the science or study of blood and blood diseases.
• Haematological tests can help diagnose anemia,

infection, hemophilia, blood-clotting disorders, and

leukemia.
9.2.1 BLOOD
• Blood is a specialized fluid connective tissue that

consists of plasma, corpuscles (RBC and WBC), and platelets. It circulates

throughout the body.
Functions of blood
• Transportation of vital elements (such as nutrients, oxygen, and hormones

etc.) to cells, tissues, and organs.

• Elimination of waste from cells, tissues, or organs.

• Regulation of body temperature (Thermoregulation).

Blood Composition
• Blood is made up of several different types of blood cells suspended in a

clear, straw-coloured fluid called plasma.

 • Cellular substances (Blood cells): 45%
(44% RBC and 1% buffy coat containing platelets and WBC)
• Plasma: 55%

(Total: 91% liquid and solid 9%)

• Normal range of platelets: 0.15–0.4 million/mm³

• White blood cells (WBCs) are divided into two types:

1. Granulocytes
• Neutrophils: 40–70%

• Eosinophils: 01–04%

• Basophils: 00–01%

2. Agranulocytes
• Lymphocytes: 20–45%

• Monocytes: 02–10%

Types of blood cells

The three main types of blood cells are:
• Red blood cells (Erythrocytes)

• White blood cells (Leukocytes)

• Platelets (Thrombocytes)
9.2.2 COMMON HAEMATOLOGY TESTS FOR BLOOD
Complete Blood Count (CBC):
Complete blood count test includes:
• White blood cell count (WBC)

• Red blood cell count (RBC)

• Platelet count

• Hematocrit red blood cell volume (HCT)

• Hemoglobin concentration (HB)

• Differential white blood count

• Red blood cell indices (measurements)

Table – Interpretation of Clinical Laboratory Test of Blood

9.3 LIVER FUNCTION TEST
9.3.1 LIVER
• It is the largest (internal) organ in human body and can

weigh up to 1.5 kg for an adult human.

 • It is situated in the abdominal cavity, just below the diaphragm and has two
lobes.
9.3.2 MAJOR FUNCTION OF LIVER
• Metabolic functions: The liver actively participates in carbohydrate, liquid,

protein, mineral and vitamin metabolism.

• Excretory functions: Bile pigments, bile salts, and cholesterol are excreted in

the bile into the intestine.

• Protective functions and detoxification: Liver is responsible for metabolism

of xenobiotics (Detoxification).
• Haematological functions: Liver participates in the formation of blood,

synthesis of plasma proteins and destruction of erythrocytes.

• Storage functions: Glycogen, vitamins A, D, B₁₂, and trace elements are
stored in the liver.
9.3.3 CLASSIFICATION OF LIVER FUNCTION TESTS

1. Test based on excretory function

A. Serum bilirubin estimation
Van Den Bergh Reaction
• Heme breakdown results in the excretory end product bilirubin, a bile

pigment.
• In the liver, it is combined to create bilirubin di-glucuronide, and released as

bile.
• Serum bilirubin levels should normally be between 0.2 and 1.0 mg/dl.

• Principle of Van Den Bergh Reaction

• Van den berg reagent: equal composition of Sulphanilic acid in dilute

Hydrochloric acid (HCl) and Sodium nitrite (NaNO₂)

Significance:
• Van den Bergh reactions distinguish the type of jaundice:

o Hemolytic jaundice – Indirect positive

o Obstructive jaundice – Direct positive

o Hepatic jaundice – Biphasic

B. Urine bilirubin
• Water soluble bilirubin (conjugated bilirubin) is eliminated through urine

whereas unconjugated ones are not excreted in urine.

• Fouchet’s test can detect the bilirubin presence in urine.

Fouchet’s test
10 ml urine + Barium chloride (few ml)
↓
Filter the urine
↓
 Add one drop of ferric chloride on the filtrate obtained on filter paper
↓
Green blue spot appears
↓
Confirms bilirubin in urine
C. Urobilinogen in urine
• Amount of urobilinogen present in urine depends on the amount of bilirubin

entering the intestine.

• Urine urobilinogen is estimated semi-quantitatively by Ehrlich's aldehyde

reagent.
Ehrlich's aldehyde reagent: Prepared by dissolving 4 g of p-dimethyl amino
benzaldehyde in 100 ml concentrated HCl and then 100 ml distilled water.

Significance: Increased urobilinogen in urine indicates hemolytic jaundice.

D. Bromosulphthalein (BSP) dye test
• To estimate the excretory function of liver, Bromosulphophthalein, a

nontoxic dye, is used.

• In normal liver function, the dye must be cleared within 45 minutes.

Significance: Increased time to excrete BSP indicates abnormal liver functioning,

especially related to excretory function.
2. Test based on detoxification function
A. Determination of blood ammonia
• Liver detoxicates ammonia to form urea.

• In liver disorder, the ability to remove ammonia may be impaired.

• Normal range: 40–70 µg/dl of blood

 • Significance: High ammonia levels are found in acute hepatitis and cirrhosis.
B. Hippuric acid test
• The primary location of xenobiotic metabolism (detoxification) is the liver.

• Measurement of hippuric acid synthesis evaluates the liver’s detoxification

capacity.
• Liver produces hippuric acid when benzoic acid and glycine combine.

3. Test Based on Hematological Function

• Liver is the main source of synthesis of plasma proteins, e.g., albumin,

globulin.
• Blood clotting factors: fibrinogen, prothrombin, factors V, VII, IX, X.

A. Determination of serum albumin and globulin

• Two major proteins in serum are albumin and globulin.

• Salt fractionation and electrophoresis are used to separate different proteins.

Normal concentrations:
• Serum albumin: 3.7–5.3 gm/dl

• Serum globulin: 1.8–3.6 gm/dl

Significance:
• Albumin decreases in nephrotic syndrome and hemodilution.

• Globulin decreases in shock, burns, hemorrhage; increases in multiple

myeloma, macroglobulinemia, chronic liver disease.

B. Determination of prothrombin time
• Clotting factors are synthesized in liver.

• Deficiency causes prolonged prothrombin time, indicating liver damage.

4. Determination of Serum Enzymes
• Liver cells contain several enzymes.

• In liver damage, these enzymes are released into blood.

A. Serum alkaline phosphatase (ALP)

• Estimated by King and King method.

• Phenyl phosphate → Phenol → reacts with 4-amino phenazone → Red-

purple color (520 nm)
Normal range:
• 4–17 KA units/dl

Significance:
• Increased in hepatitis, liver cancer, osteomalacia, Paget’s disease, pregnancy

(last trimester).
• Decreased in cretinism, severe anemia, kwashiorkor.

B. SGOT and SGPT

SGOT (AST)
• Converts aspartate + α-ketoglutarate →
oxaloacetate + glutamate.
SGPT (ALT)
• Converts alanine + α-ketoglutarate → pyruvate +
glutamate.
Normal range:
• SGOT: 4–17 IU/L

• SGPT: 3–15 IU/L

Significance:
• SGOT > SGPT → myocardial infarction
• SGPT > SGOT → viral hepatitis / toxic liver disease
5. Test Based on Metabolic Function
A. Galactose tolerance test
• Galactose is converted to glucose in liver.

• This process is impaired in hepatocellular damage.

Significance:
• Galactose half-life (10–15 min) increases in liver cirrhosis, infectious

hepatitis.

9.4 RENAL FUNCTION TEST

• A very common test performed in hospitals, clinics,
emergency departments, and laboratories.
• Urinary system consists of pair of kidneys and urinary

tracts.
9.4.1 FUNCTION OF KIDNEY
• Urine formation

• Regulation of water, electrolytes, and acid-base balance

• Removal of metabolic wastes

• Reabsorption of glucose and amino acids

• Endocrine functions (erythropoietin, calcitriol, renin)

Urine Formation
• Nephrons are functional units (~1 million/kidney).
 • Components: Bowman’s capsule, PCT, Loop of Henle, DCT, collecting
tubule
Steps:
1. Glomerular filtration
2. Tubular reabsorption
1. Glomerular filtration
• Passive mechanism forming ultrafiltrate of blood.

• Molecules <70,000 MW pass into filtrate.

2. Tubular reabsorption
• Water and solutes are reabsorbed by renal tubules.

• Urine composition differs from filtrate.

9.4.2 RENAL FUNCTION TEST
Purpose:
• Diagnose kidney and urinary tract disorders

• Urine examination helps detect kidney disease

Classification of renal function tests

1. Urine analysis
2. Tubular function tests
3. Glomerular function tests

1. Urine analysis
A. Physical Examination
• Colour, appearance, odour, specific gravity, osmolarity

B. Chemical Examination
• Urine pH

• Glucose, protein, ketone bodies, blood

• Normal pH: 4.5–8.0

C. Microscopic Examination
• Detects:

o Cells (RBC, WBC, pus cells)

 o Crystals (calcium oxalate, phosphate)
o Casts (hyaline, granular, RBC casts)

2. Tubular function tests

• Assess concentrating and diluting ability of kidney

• Depends on tubular reabsorption and ADH presence

A. Urine concentration test

• This test is performed to evaluate the renal tubular function.

• In this test specific gravity is measured, which varies according to

concentration; osmolality can also be evaluated.

Normal values:
• Osmolality: 275–900 mOsm/kg

• Specific gravity: 1.002–1.035

B. Acid load test or ammonium chloride loading test

• The acid loading test (pH) measures the ability of the kidneys to send acid to

the urine when there is too much acid in the blood.

• This test involves both a blood test and urine test.

• Used for the diagnosis of renal tubular acidosis.

3. Glomerular function test

• These tests are performed to assess the glomerular filtration rate (GFR).

A. Clearance test
• Clearance is defined as the volume of plasma (in ml) which contains the

amount of substance that is excreted by kidney in urine in 1 minute.

• Renal clearance (C) is calculated by:

𝑈×𝑉
𝐶=
𝑃
Where:
• C = Renal clearance (GFR of a substance in ml/minute)

• U = Concentration of substance in urine (mg/dl)

• V = Volume of urine in ml excreted per minute

• P = Concentration of substance in plasma (mg/dl)

• Clearance value is inversely proportional to renal failure; with decrease in

clearance value, renal failure increases.

a. Creatinine clearance tests
• Creatinine clearance is defined as the volume of plasma (in ml) that would

be completely cleared of creatinine per minute.

• Creatinine clearance resembles GFR (125 ml/min).

Normal value:
• 120–145 ml/min

Significance:
• A lowered GFR is indicated by a creatinine clearance result (< 75% normal)

due to kidney injury.

b. Urea clearance test
• Urea clearance is defined as the volume of plasma (in ml) that would be

completely cleared of urea per minute.

• Urea is filtered by glomeruli and reabsorbed partially by renal tubules.

• Urea clearance is not as sensitive as creatinine clearance.

• Its value is less than GFR.

Normal value:
• 54 ml/min
Significance:
• Renal damage is indicated by urea clearance value.

B. Blood analysis
• To broadly evaluate kidney function, serum creatinine and blood urea levels

are estimated.
• Impaired glomerular filtration results in retention of urea and creatinine,

which elevates their levels in blood.

Normal Value:
• Serum creatinine level:

o Adult male: 0.74 to 1.35 mg/dL

o Adult women: 0.59 to 1.04 mg/dL

• Blood urea level: 5 to 20 mg/dl

Significance:
• Serum creatinine rises in all cases where serum urea rises.

• It is a more sensitive and specific indicator of renal dysfunction because it is

not affected by exogenous factors like urea.

9.5 THYROID FUNCTION TESTS (TFTs)

9.5.1 INTRODUCTION
• Thyroid function tests are a series of blood tests used to measure how well

the thyroid gland is working.

• Thyroid gland and parathyroid gland are involved in thyroid function.

• Thyroid gland: Influences body growth, metabolism, thyroxine (T₄) and tri-
iodo thyronine (T₃).
 • Parathyroid gland: Parathyroid hormone (Parathormone) regulates serum
calcium and phosphorus levels.

9.5.2 THYROID FUNCTION TESTS

Blood tests:
• Blood tests to measure these hormones are readily available and widely used.

• Tests include:

TSH (Thyroid stimulating hormone) tests

• The best way to initially test thyroid function is to measure TSH level in

blood.
• Changes in TSH serve as an “early warning system” before hormone levels

become abnormal.
• High TSH level:

Indicates thyroid gland is not making enough thyroid hormone (Primary

hypothyroidism).
 • Low TSH level:
Indicates thyroid is producing too much hormone (Hyperthyroidism).
May also result from pituitary abnormality (Secondary hypothyroidism).

T₄ (Thyroxine) tests
• T₄ is the main form of thyroid hormone circulating in blood.
• Total T₄: Measures both bound and free hormone.
• Free Thyroxine (FT₄): Measures unbound hormone available to tissues.
• Tests measuring free T₄: Free T₄ (FT₄) or Free T₄ Index (FTI) give more
accurate thyroid function assessment.
Significance:
• High TSH + Low FT₄/FTI → Primary hypothyroidism
T₃ (Triiodothyronine) tests
• Useful for diagnosis of hyperthyroidism.

• Hyperthyroid patients show elevated T₃ levels.

• Sometimes:
 o TSH is low
o Only T₃ is elevated
o FT₄/FTI remains normal
• T₃ testing is less useful in hypothyroidism (last to become abnormal).
• Severe hypothyroidism:
o High TSH

o Low FT₄/FTI
o Normal T₃
➤ Thyroid antibody tests
• The immune system protects the body from foreign invaders such as bacteria

and viruses by destroying these invaders with substances called antibodies

produced by blood cells known as lymphocytes.
• In many patients with hypothyroidism or hyperthyroidism, lymphocytes

react against the thyroid (thyroid autoimmunity) and make antibodies against
thyroid cell proteins.
➤ Non-blood tests
Radioactive iodine uptake
✔ T₄ contains iodine, the thyroid gland pulls a large amount of iodine from the
bloodstream in order to make an appropriate amount of T₄.
✔ The thyroid has developed a very active mechanism for doing this. Therefore,
this activity can be measured by having an individual swallow a small amount of
iodine, which is radioactive.
✔ By measuring the amount of radioactivity that is taken up by the thyroid gland
(Radioactive Iodine Uptake, RAIU), doctors may determine whether the gland is
functioning normally.
✔ A very high RAIU is seen in individuals whose thyroid gland is overactive
(hyperthyroidism)
✔ A low RAIU is seen when thyroid gland is underactive (hypothyroidism)

9.6 TESTS ASSOCIATED WITH CARDIAC DISORDERS

• Cardiovascular diseases (CVDs) are a group of disorders of the heart and
blood vessels.
9.6.1 COMMON TESTS TO DIAGNOSE HEART CONDITIONS
• Blood tests
✔ When muscle has been damaged, as in a heart attack, body releases
substances in blood. Blood tests can measure the substances and show if, and how
much of, heart muscle has been damaged.
• Electrocardiogram (ECG)
✔ An ECG reads the heart’s electrical impulses. It
shows how well the heart is beating.
✔ A doctor may use an ECG to diagnose a heart attack
or abnormal heart rhythms (called ‘arrhythmias’).
• Exercise stress test
✔ A stress test, sometimes called a ‘treadmill’ or
‘exercise’ test, is a type of ECG that is done while you
are exercising.
✔ It helps the doctor to find out how well the heart works when patient is
physically active.
• Echocardiogram (ultrasound)
✔ An echocardiogram is a common test. It gives a picture
of the heart using ultrasound, a type of X-ray.
✔ It uses a probe either on your chest or down your
oesophagus (throat).
• Nuclear cardiac stress test
✔ This test is sometimes called an ‘exercise thallium
scan’, a ‘dual isotope treadmill’, or an ‘exercise
nuclear scan’.
✔ The doctor uses this picture to see how much blood flows to heart muscle and
how well the heart pumps blood when the patient is resting and doing physical
activity.
• Coronary angiogram
✔ A coronary angiogram, sometimes called ‘cardiac
catheterization’, may be done after a heart attack or angina.
✔ The X-ray shows the doctor where and how much coronary
arteries are clogged or blocked. It also shows how well the heart
is pumping.
• Magnetic Resonance Imaging (MRI)
✔ An MRI uses very strong magnets and radio waves
to create detailed images of the heart on a computer.
✔ It can take still or moving pictures of the heart.
• Coronary Computed Tomography Angiogram (CCTA)
✔ This is a specialized type of computed
tomography (CT) scan that may be used to help
diagnose coronary artery disease.

9.7 FLUID AND ELECTROLYTE BALANCE

9.7.1 FLUIDS
• 60% of body weight is provided by water.

Average daily water consumption

✔ Men: 60% of body weight
✔ Women: 55% of body weight
• Water increase (More than normal): Associated with impaired water

excretion, such as renal failure.

 • Water decrease (Less than normal): Associated with excessive loss of water,
raised sodium level, severe loss of water may induce cerebral dehydration
and circulatory failure.
• Loss of body fluids by as much as 20–30% leads to severe dehydration and

death.
• Sodium is a major ion extra cellular fluid.

• Potassium is major ion of intra cellular fluid.

• Calcium is mostly found in skeletal tissue.

9.7.2 ELECTROLYTE
• Electrolytes are substances that have a natural positive or negative electrical

charge.
• Electrolyte found in our body include sodium, potassium, chloride, calcium,

magnesium, phosphate, bicarbonate.

• The main electrolytes in body include:

Table – Electrolytes normal range in plasma and their role

NORMAL RANGE IN
ELECTROLYTE ROLE
PLASMA
Helps to control the amount of fluid in the
Sodium (Na⁺) 135–145 mEq/L
body
Helps cells, heart, and muscles to work
Potassium (K⁺) 3.5–5.5 mEq/L
properly
Helps to make and keep bones and teeth
Calcium 8.5–10.5 mg/dl
strong
Helps muscles, nerves, and heart to work
Magnesium 1.5–2.5 mEq/L
properly
 NORMAL RANGE IN
ELECTROLYTE ROLE
PLASMA
Maintains blood pH to prevent metabolic
Bicarbonate (HCO₃) 22–29 mEq/L acidosis
Helps to control the amount of fluid in the
Chloride 96–106 mEq/L
body
Works together with calcium to build
Phosphate 2 mEq/L
strong bones and teeth
Protein 15 mEq/L Helps repair and build body tissues

➤ Electrolyte imbalance
✔ An electrolyte imbalance means that the level of one or more electrolytes in
body is too low or too high.
✔ It can happen when the amount of water in your body changes.
✔ The amount of water that you take in should equal the amount you lose.
Table – Different Types of Electrolyte Imbalances
ELECTROLYTE TOO LOW TOO HIGH
Bicarbonate Acidosis Alkalosis
Calcium Hypocalcemia Hypercalcemia
Chloride Hypochloremia Hyperchloremia
Magnesium Hypomagnesemia Hypermagnesemia
 ELECTROLYTE TOO LOW TOO HIGH
Phosphate Hypophosphatemia Hyperphosphatemia
Potassium Hypokalaemia Hyperkalaemia
Sodium Hyponatremia Hypernatremia

➤ Tests for Electrolytes

✔ • Basic metabolic panel
BUN (blood urea nitrogen): This is a test that
shows how well kidneys are functioning and may
suggest dehydration.
Blood sugar: This test may indicate diabetes or prediabetes if you are fasting.
✔ Comprehensive metabolic panel: This test is similar to the
basic metabolic panel but with additional data gathered.
✔ Electrolyte panel: This is a broader test like the metabolic
panels, but it only looks for electrolytes. The electrolytes
analyzed include sodium, chloride, potassium and bicarbonate.
Table – Specific test for electrolytes
TESTS DESCRIPTION
Aldosterone blood test This test looks for a specific hormone produced by your kidneys.
Aldosterone 24 hours This test also looks for aldosterone but does so using several
urine test urine samples collected during a 24-hour timeframe.

Anion gap blood test The test compares the levels of specific electrolytes to see if
there's a difference between the measured levels of positive-
 TESTS DESCRIPTION
charge and negative-charge electrolytes, which may be a sign of
certain conditions.
Carbon dioxide blood This test measures the amount of carbon dioxide in blood. That
test level indicates if blood is too acidic or too basic.
This test analyses blood sample for the level of chloride found in
Chloride blood test
blood.
Magnesium blood test This test analyses levels of magnesium in blood.
This test measures the amount of certain substances in body. It's
Blood osmolality test used in cases of dehydrated, overhydrated or when poisoning is
possible or suspected.
Phosphorus blood test This test measures the amount of phosphorus in blood.
Sodium blood test This test measures the level of sodium in blood.
This test measures the amount of sodium in urine. It can involve
Sodium urine test
multiple samples collected over a period of 24 hours.

9.8 PULMONARY FUNCTION TEST

9.8.1 INTRODUCTION
• Pulmonary function tests (PFTs) are non-

invasive tests that show how well the lungs

are working.
• The tests measure lung volume, capacity,

rates of flow, and gas exchange.

• There are two types of disorders that cause problems with air moving in and

out of the lungs:

✔ Obstructive: This is when air has trouble flowing out of the lungs due to airway
resistance. This causes a decreased flow of air.
✔ Restrictive: This is when the lung tissue and/or chest muscles can’t expand
enough. This creates problems with air flow, mostly due to lower lung volumes.
9.8.2 TYPES OF PULMONARY FUNCTION TESTS (PFTS)
1. Spirometry
• A spirometer is a device with a mouthpiece hooked up to a small electronic

machine.
• It helps to detect airways obstruction, manifested in asthma or COPD.

• The information collected by the spirometer may be printed out on a chart

called a spirogram.
• The physical forces of air flow and the total amount of air inhaled and
exhaled are converted by transducers to electrical signals, which are
displayed on computer screen.
 Table – Parameters and Description
PARAMETERS DESCRIPTION
This is the amount of air inhaled or exhaled during normal
Tidal volume (TV)
breathing
This is the total volume of air that can be exhaled after
Vital capacity (VC)
inhaling as much as you can
Functional residual This is the amount of air left in lungs after exhaling
capacity (FRC) normally
This is the amount of air left in the lungs after exhaling as
Residual volume (RV)
much as you can
This is the total volume of the lungs when filled with as
Total lung capacity (TLC)
much air as possible
Forced vital capacity This is the amount of air exhaled forcefully and quickly
(FVC) after inhaling as much as you can
Forced expiratory volume This is the amount of air expired during the first, second,
(FEV) and third seconds of the FVC test
Forced expiratory flow This is the average rate of flow during the middle half of
(FEF) the FVC test
Peak expiratory flow rate This is the fastest rate that you can force air out of your
(PEFR) lungs

2. Body Plethysmography
• You sit or stand inside an air-tight box that looks like

a short, square telephone booth to do the tests.

 • A plethysmography test measures the volume of gas in your lungs, known as
lung volume.
3. Pulse oximetry test
• A pulse oximetry test does not require breathing

into a machine or monitored exercising.

• The purpose of this test is to measure the saturation of oxygen in your red

blood cells.
4. Diffusion capacity test
• This test evaluates how well the small air sacks

inside the lungs, called alveoli, work.

• For this part of a pulmonary function test, you

will be asked to breathe in carbon monoxide.

5. Cardiopulmonary exercise test
• A cardiopulmonary exercise test is a specialized

exercise stress test to gauge your ability to

exercise and to diagnose what may be restricting
your activity levels.
6. Six-minute walk test
• This test measures the maximum distance

the patient is able to walk in six minutes.

7. Bronchial provocation test
• A bronchial provocation test evaluates the sensitivity of your lungs.

• It’s often used to diagnose or rule out asthma as a cause of your symptoms.