Lung Function Laboratory Referral Form

Please fill out the referral form below:

We are a Southern Cross Affiliated Provider

Sleep & Breathing (NZ) Limited
Ascot Office Park, Level 3, Building B
93-95 Ascot Avenue, Greenlane East
P O Box 109-409, Newmarket
Auckland 1149
Fax 09 638 6022
Telephone 09 638 5255
Email referrals@nzrsi.health.nz
 
 

PATIENT'S DETAILS

TEST REQUESTED (Patients should withhold inhalers on the day of the test)














CLINICAL DETAILS

REFERRING DOCTOR

Fields marked * are required

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Phone Southern Cross on 0800 800 181

Spirometry with Flow/Volume loops:

Assessment of possible upper airways obstruction, asthma or COPD and to follow progress

Lung volumes and flows with DLCO:

Our usual routine test for assessment of lung disease and to monitor progress. Always done with spirometry

Exercise VO2 assessment:

For unexplained breathlessness, fitness for surgery or impairment assessment for occupational lung disease

6 minute walk test:

To follow patients with ILD, COPD or for home oxygen assessment

Challenge testing:

Methacholine - To assess for asthma
Hypertonic saline - To assess asthmatic divers. Less sensitive, but more specific than Methacholine
Mannitol - Prior to use of Mannitol therapy in airways disease
Exercise - Exercise induced asthma

Induced sputum:

TB - 3 tests on successive days, is as effective as bronchoscopy for exclusion of TB
Airways assessment - Useful in the assessment of chronic cough or airways disease, or if uncertainty about a diagnosis of asthma. Looks for Eosinophils, Polymorphs and lipid laden Macrophages

FENO

Assessment of steroid naive asthmatics and to assess response to inhaled corticosteroid or to assess asthmatic patients on inhaled steroids but with continued symptoms