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.Important instructions for patients visiting the lab:
Please come equipped with the funding commitment form (Form 17) of your health maintenance organization (HMO), or with cash as standard fees may apply (IMH regulations).
Note that no procedure will be done without an accompanying physician's letter of referral.
Pulmonary Function Testing Unit
Abnormality in pulmonary function tests can be caused by a disease in the alveolus walls that decreases gas exchange (primarily blood oxygen) or by problems with air flow through the airways that cause obstruction, which makes it difficult for air to enter and exit the alveolar units.
Spirometry is a non-intrusive and effective method of testing lung function. A spirometer checks the volume of air inhaled and exhaled, and the airflow speed. The patient breaths into a tube connected to a drum. The test is simple; however, it requires full patient cooperation.
The test is used for several situations:
- Diagnosing lung disease in patients experiencing shortness of breath
- Following up on lung treatment effectiveness
- Evaluating lung function prior to surgery
- Following up on patients taking medication that could impact lung function
When diagnosis cannot be made strictly by conventional pulmonary function testing, pulmonary challenge tests are used.
Pulmonary challenge tests:
- Methacholine challenge test
In pulmonary challenge testing, the patient inhales consistently increasing concentrations of substances (methacholine) 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.
- Pulmonary function testing before and after exercise test
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 as 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. To predict the level of in-flight distress and enable the appropriate treatment, travelers can undergo the high-altitude simulation lung test (HAST).
Testing principles: For a duration of 10 minutes, 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 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.
Testing principles: The patient walks on a straight, flat surface for six minutes, and the distance covered is measured.
- Impulse Oscillometry (IOS)
The test involves a machine that superimposes sound waves on a normally breathing patient. During this time, the machine detects the pattern in which the waves move and calculates different parameters of the patient's lung function.
The IOS test is usually used when patient cooperation in performing a simple spirometry is limited (e.g. children younger than 6 years of age and adults suffering from cognitive decline).
Testing principles: The patient breaths normally into the machine mouthpiece for 30 seconds, before and after administration of bronchodiltaors. 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 on 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 a lightweight, hard and good electrical conductor, that does not create a magnetic field, and is 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 metals
In order to detect 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 samples of induced sputum.
Many workers are exposed to hazardous dust at work. This dust may contain high levels of minerals which may be the cause of several diseases that cause severe impairments in lung function.
MELISA is a blood test that identifies sensitivity of the immune system to those metals, and can be used to demonstrate the link between their presence in the lung and diseases.
The test can also be used to demonstrate hypersensitivity to dental and orthopedic implants http://www.melisa.org.
The entire list of metals can be seen in the list
The test can be paid with cash, or with HMO cover. Appointments and further information can be obtained at 03-6973749.
- Ours, is the only laboratory licensed to perform the test in Israel
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 in:
- Diagnosing chronic cough
- Diagnosing asthma and hyperactive airways
- Diagnosing interstitial lung diseases: induced sputum can be used instead of fibro-optic bronchoscopy for patients in which lung biopsies cannot be retrieved
- Identifying occupational illnesses in workers exposed to hazardous dust, such as silica or hard metals
- Diagnosing inflammatory conditions of the airways due to fungal infections, which cause serious asthma-like conditions that don't respond to conventional treatments
Special tests:
RAST
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 attach to allergens and 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?
RAST identifies:
- Sensitivity to inhaled allergens, such as house dust, mold, pollen, cats, dogs, insects, etc.
- Sensitivity to foods, such as milk, eggs, grains, fruit, etc.
- Sensitivity to specific components of milk, eggs and peanuts
* The entire list of allergens is enlisted here
ADA
This test checks the presence of the enzyme in various body fluids (pleural, peritoneal, pericardial, abdominal, CSF), for diagnosing tuberculosis in the region from which the fluid was taken - for example in the pleura of the lung. The test is used to diagnose tuberculosis, when the disease cannot be diagnosed by conventional clinical and laboratory means. The enzyme is found naturally and widely in human cellular tissues, with even more elevated enzyme levels in people suffering from tumors, viral hepatitis, cirrhosis of the liver and tuberculosis.
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, 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 Plus (QFT-Plus)
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.
Both these tests are available in our laboratory, and will be performed at the specific request of a physician's letter of referral.
