The CE provider will describe and discuss, as appropriate:

a. Dyspnea at rest and/or with exertion;

b. How much activity causes dyspnea (for example, distance the claimant can walk and how many flights of stairs they can climb before resting);

c. Palpations, wheezing, cough, sputum production, chest discomfort, paroxysmal nocturnal dyspnea, and orthopnea;

d. Characteristics of severe respiratory attack or persistent pulmonary infection;

e. History of hospital admissions or emergency department visits; and

f. Episodic disorders, such as asthma:

1. Onset and precipitating factors;

2. Frequency and intensity;

3. Duration;

4. Mode of treatment and response;

5. Compliance with therapy including frequency of inhaler use; and

6. Description of a severe attack.

The CE provider will describe and discuss, as appropriate, any tobacco use, substance use, or any employment history relevant to the condition such as exposure to fibrotic agents, chemicals, or irritants.

The CE provider will describe and discuss, as appropriate:

a. Assistive devices: presence of tracheostomy, central venous catheter, or gastrostomy;

b. The presence of, or need for supplemental oxygen and for what period (for example, all the time, with exercise, at night, etc.);

c. Respiratory rate: whether respirations are labored, and use of accessory muscles of respiration;

d. Lungs:

1. Occurrence of cough, audible wheezing, pallor cyanosis, hoarseness, clubbing of fingers, chest wall deformity, and any abnormal curvature of the spine;

2. Whether there is prolongation of the expiration phase or respiration;

3. Quality of breath sounds (or air exchange), whether normal or diminished;

4. Presence of adventitious sounds (such as wheezing, rhonchi, or rales); and

5. Diaphragmatic motion.

d. Heart and vascular:

1. Description of heart sounds;

2. Presence of any lifts, heaves, or thrills;

3. Heart size;

4. Point of maximal impulse of cardiac apex;

5. Presence of any murmurs, rubs, or gallops;

6. Presence and location of any bruits;

7. Distention of neck veins; and

8. Presence, type, and extent of any peripheral edema and any associated skin discoloration or ulceration.

e. Pulmonary Function Tests

The CE provider will obtain pulmonary function tests only after receiving proper authorization from the DDS.

1. Spirometry: Perform as specified in section 3.00E of the respiratory listings (see DI 34001.014).

2. Diffusing capacity of the lungs (DLCO) test: Perform as specified in section 3.00F of the respiratory listings (see DI 34001.014).

3. Arterial blood gas (ABG) test: Perform as specified in section 3.00G of the respiratory listings (see DI 34001.014).

4. Pulse oximetry: Perform as specified in section 3.00H of the respiratory listings (see DI 34001.014).