The Laboratory of Pulmonary and Allergic Diseases is the only center in Israel that performs induced sputum testing as part of the comprehensive diagnostic battery for respiratory diseases, such as asthma, and for occupational lung diseases.
Instructions: Patients visiting the lab should bring the funding commitment form (Form 17) from their health maintenance organization (HMO) or cash for standard fees as defined by the Israel Ministry of Health.
Progressive research and education
In addition to extensive testing, the lab conducts research and development for innovative tests that are among the most advanced in Israel and the world. The laboratory is affiliated with the University of Tel Aviv, hosting programs for MSc and PhD students.
Pulmonary Function Testing Unit
Abnormality in pulmonary function tests can be caused by disease in the alveolus walls that decrease gas exchange (primarily blood oxygen) or by problems with air flow through the airways that cause obstruction, which make it difficult for air to enter and exit the alveolar units.
A spirometry is one simple, effective method of testing lung function. A spirometer checks the volume of air inhaled and exhaled in a given time period and airflow speed via a tube connected to a drum. The test is simple; however, it requires full patient cooperation.
The test is used to:
- Diagnose lung disease in patients experiencing shortness of breath
- Follow up on lung treatment effectiveness
- Evaluate lung function prior to surgery
- Follow up on patients taking medication that could impact lung function
In cases in which a diagnosis cannot be made strictly by conventional pulmonary function testing, pulmonary challenge tests are used.
Pulmonary challenge tests
Methacholine and adenosine challenge tests
In pulmonary challenge testing, the patient inhales consistently increasing concentrations of substances (methacholine or adenosine) that cause the airways to contract. If lung function decreases by 15% to 20%, the patient has respiratory hyperactivity, which is one of the first symptoms of asthma. Subsequent inhalation, which restores lung function to normal, helps to confirm an asthma diagnosis. Test duration depends upon the patient’s response to the inhalants. If the response is negative to all concentrations of the substance, the test can last for up to 90 minutes.
Pulmonary function testing before and after exercise
This test evaluates patients before and after exertion (running on a treadmill for 10 minutes), to help diagnose exercise-induced asthma.
Pre-flight lung testing: high-altitude simulation test (HAST)
Patients with chronic illnesses, such bronchitis, emphysema, serious asthma, and interstitial lung diseases, who are planning to take plane flights, are at risk of hypoxemia (deficit of oxygen in the blood) due to decreased concentration of oxygen in the airplane cabin. These travelers complain of general weakness, dizziness, blurred vision, headaches, difficulty breathing, and nausea. In order to predict the level of in-flight distress and enable the appropriate treatment, travelers can undergo the high-altitude simulation lung test (HAST), which predicts the need for supplementary oxygen during the flight.
High-altitude simulation lung test
For a duration of 10 minutes during the test, the patient receives the same concentration of oxygen as available in-flight. The test results determine whether the patient needs supplementary oxygen during the flight. If oxygen is needed, the pulmonologist provides a letter outlining the amount and concentration of oxygen needed. The test is short and simple. It prevents in-flight discomfort due to oxygen deficit.
This test checks the subject during a six-minute walk in order to assess his or her day-to-day respiratory abilities. The test is easy and reliable, even for patients who have difficulty walking due to shortness of breath. The test is generally used as a baseline measure prior to medical treatment.
The patient walks on a straight, flat surface for six minutes, and the distance covered is measured.
Occupational lung disease (OLD) assessment
What are occupational illnesses?
An occupational illness is any abnormal health condition caused by a work environment. Symptoms of these illnesses can be like icebergs – with minor symptoms at the surface and additional conditions hiding underneath that are not identified or reported.
Chronic beryllium lung disease assessment
What is beryllium?
Beryllium is a popular metal found in nature; it is lightweight, hard, a good electrical conductor that does not create a magnetic field, and easy to use.
What is chronic beryllium lung disease?
Chronic beryllium lung disease is a systemic syndrome caused by inhaling beryllium fumes. The illness is common in industries and products developed during the twentieth century, such as electronics, pure metal processing, or processing with aluminum and copper, ceramics, dental technology, atomic power, aeronautics, metal mining, and fluorescent products.
The beryllium lymphocyte transformation test
The best way to differentiate between chronic beryllium lung disease and other conditions, such as sarcoidosis, is through the beryllium lymphocyte transformation test (BELT). This blood test exposes patient cells to beryllium; if the patient has been exposed to beryllium, the immune cells replicate quicker. Final proof of the disease requires further clinical parameters, such as result abnormalities of a chest x-ray, abnormalities of lung function, and tissue biopsy demonstration.
This test is performed exclusively in the Tel Aviv Sourasky Medical Center’s lab, certified by the Ministry of Health as a national referral center.
Electron microscope test for discovering metal in the lungs
In order to detect asbestos, silicon, and metal fibers in the lungs, a scanning electron microscope is used. The test can be performed on the lung biopsy specimen in patients who have undergone a bronchoscopy or by using an induced sputum samples.
Determining and measuring harmful dust particles in the lungs
Dust particle types that have invaded respiratory pathways following serious or repeated industrial exposure are identified using specialized laser equipment. The test is conducted using an induced-sputum sample and is still in the research phase. Additional information is available on the Israel Institute for Occupational Safety and Hygiene (IIOSH) website.
Identifying inflammatory respiratory diseases
What is an inflammation?
An inflammation is a response of the immune system to any physical entity, foreign chemical or element that invades the body. Asthma is an inflammatory lung disease that is characterized by over-response to different irritants.
Induced sputum test
The induced sputum test is a method to obtain a sputum sample from the deepest areas within the bronchial tree—for patients who cannot give sputum samples spontaneously. The test is used to:
- Diagnose chronic cough
- Diagnose asthma and hyperactive airways
- Diagnose interstitial lung diseases: induced sputum can be used instead of fibro-optic bronchoscopy for patients in which lung biopsies cannot be retrieved
- Identify occupational illnesses in workers exposed to hazardous dust, such as silica, asbestos, or hard metals
- Diagnose inflammatory conditions of the airways due to fungal infections, which cause serious asthma-like conditions that don’t respond to conventional treatments
Exhaled nitric oxide (NO) testing
Nitric oxide is a gas that is produced by the respiratory tract, and high concentration in exhaled air indicates the presence of inflammatory conditions or diseases such as asthma.
The test is important for monitoring asthma, both in order to find the most adequate treatment to prevent overuse of inhalers and to avoid attacks due to inappropriate treatment dose. The test is the only tool available to diagnose pneumonia and shortness of breath in children up to the age of six, when the diagnosis is uncertain.
Special blood tests
RAST - Radioallergosorbent test for identifying allergy causes
The RAST blood test measures the specific site for food and environmental allergens within the IgE (Immunoglobulin E) antibody. In this test, the allergen can be found in either a solid or a chemical suspension. The antibodies present in the blood and attach to allergens to create a complex. Identifying the complex is done by a colorimetric enzymatic reaction. The intensity of the color is correlated directly to the quantity of antibodies in the blood serum.
What can be determined from this test?
- Sensitivity to inhaled allergens, such as house dust, mold, pollen, cats, dogs, insects, latex, etc.
- Sensitivity to foods, such as milk, eggs, grains, fruit, etc.
Specialized enzyme testing: ACE (angiotensin converting enzyme) and ADA (adenosine deaminase)
- ACE is a blood test that measures the angiotensin-converting enzyme for the diagnosis of sarcoidosis
- The ADA test measures the adenosine deaminase enzyme for diagnosing tuberculosis in the pleural cavity
IGRA - Interferon gamma releasing assays for identifying latent tuberculosis
About a third of the world’s population is infected with latent TB, of whom 10% typically develop active tuberculosis. Therefore, an accurate test and proper treatment is of utmost importance to control the spread of the disease.
The conventional skin-based testing is inexpensive and readily available; however, it conceals several primary problems, often causing incorrect diagnostic results. The most critical problem is that the skin test can be falsely positive for patients who received the anti-TB BCG vaccine in the past. The low sensitivity of the test is problematic specifically with the native Israeli population born before 1981 and patients vaccinated in the former Soviet Union. In addition, the skin test has low sensitivity with compromised immune systems, undernourished AIDS patients, and patients with active tuberculosis.
Based on IGRA test results, patients can, for example, avoid unnecessary antibiotic treatment.
The tests approved by the United States Food and Drug Administration (FDA) are:
- QuantiFERON®-TB Gold (QFT) - which measures the level of gamma interferon in the patient’s blood as a result of ranking cells with TB antigens
- T-SPOT.TB - which measures the cells that secrete gamma interferon, correlated with tuberculosis
BNP test for evaluating heart function
The BNP (B-type natriuretic peptide) test is used for clinical diagnosis of
- Differential diagnosis for shortness of breath due to heart or lung
- Early detection of cardiac insufficiency
- Detection of heart muscle injury following oncological