The most important initial investigation is always a complete history and physical examination
Assess risk factors including:
- Pre-existing lung disease
- Site and type of tumour
- Radiation therapy (RT)
- Pulmonary toxic chemotherapy
- Stem cell transplant
- Exposure to cigarette or marijuana smoke
Symptoms and signs:
- Cough, fever, dyspnea, exercise induced symptoms, exercise tolerance
- Respiratory rate, cyanosis, pleural effusion, rales, rhonchi
- PFTs including diffusion capacity and spirometry
- Chest X-ray
- may see pulmonary interstitial infiltrates
- High resolution CT
- Bleomycin can cause pulmonary nodules
Measurement of spirometry before and after bronchodilators
Common Terminology of Spirometry Tests:
- VC-Vital Capacity - The amount of air that can be forcibly exhaled from the lungs after a full inhalation.
- TLC-Total Lung Capacity - the maximum volume of air present in the lungs
- FVC-Forced Vital Capacity - The amount of air which can be forcibly exhaled from the lungs after taking the deepest breath possible.
- FEV1-Forced Expiratory Volume in One Second - The amount of air which can be forcibly exhaled from the lungs in the first second of a forced exhalation.
- FEV1/FVC-FEV1-Percent (FEV1%) - The ratio of FEV1 to FVC and tells the clinician what percentage of the total amount of air is exhaled from the lungs during the first second of forced exhalation.
- PEFR Peak Expiratory Flow Rate- Measures if treatment is effective in improving airway diseases such as chronic obstructive airways disease.
- FEF-Forced Expiratory Flow - A measure of how much air can be exhaled from the lungs. It is an indicator of large airway obstruction.
- DLCO-Carbon monoxide diffusing capacity of the lungs: Lung diffusion tests help determine how well oxygen passes from the alveoli, or air sacs, of the lungs to the bloodstream. The tests measure the "diffusing capacity of the lungs for carbon monoxide" or DLCO.