Version May 2024
| Setting | Tests to order in most patients | Advanced testing |
| Dyspnea at rest or on exertion | Spirometry before and after bronchodilator Lung volumes DLCO Ambulatory oximetry with stair climb | Cardiopulmonary exercise test |
| Cough | Spirometry before and after bronchodilator | Bronchoprovocation challenge testing if spirometry normal and asthma suspected |
| Asthma | Spirometry before and after bronchodilator | Bronchoprovocation challenge testing if spirometry normal and asthma suspected |
| COPD | Spirometry before and after bronchodilator Oximetry at rest | Lung volumes (can be ordered if FVC is low, chest radiograph shows hyperinflation, dyspnea is out of proportion to spirometric abnormalities) DLCO (can be ordered with initial spirometry or after irreversible airflow obstruction is identified) Ambulatory oximetry if resting oximetry is <95% Oximetry during sleep (to check adequacy of supplemental oxygen or in patients with awake, resting SpO2 <92%) |
| Suspected bronchiectasis | Spirometry before and after bronchodilator Lung volumes | |
| Suspected bronchiolitis | Spirometry before and after bronchodilator Lung volumes DLCO | |
| Suspected upper airway obstruction (eg, stridor, hoarseness and dyspnea, unexplained dyspnea) | Spirometry with flow volume loop (look at shape of curves) | |
| Suspected ILD (eg, hypersensitivity pneumonitis, sarcoidosis, idiopathic pulmonary fibrosis, or abnormal chest radiograph) | Spirometry Lung volumes DLCO Oximetry at rest Ambulatory oximetry or six-minute walk test | Cardiopulmonary exercise test may be used in evaluation for lung transplantation |
| Suspected neuromuscular or chest wall disease | Spirometry Lung volumes Maximal inspiratory force Maximal expiratory force | Arterial blood gas if FVC <1 L |
| Suspected diaphragmatic weakness | Spirometry upright and supine Lung volumes Maximal inspiratory force Maximal expiratory force |
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