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Diagnosing exercise-induced bronchoconstriction with eucapnic voluntary hyperpnea: is one test enough?

Oliver J Price1, Les Ansley2, James H Hull3

  • 1Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom.

The Journal of Allergy and Clinical Immunology. in Practice
|January 23, 2015
PubMed
Summary

Eucapnic voluntary hyperpnea (EVH) testing for exercise-induced bronchoconstriction (EIB) shows poor short-term reproducibility in recreational athletes. Clinicians should use multiple EVH tests for accurate EIB diagnosis.

Keywords:
Airway dysfunctionAthletesEucapnic voluntary hyperpneaExercise-induced bronchoconstrictionIndirect bronchoprovocation testingReproducibility

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Area of Science:

  • Sports Medicine
  • Pulmonology
  • Exercise Physiology

Background:

  • Accurate diagnosis of exercise-induced bronchoconstriction (EIB) in athletes relies on objective testing.
  • Eucapnic voluntary hyperpnea (EVH) is a recommended indirect bronchoprovocation test for EIB.
  • The short-term reproducibility of EVH requires further investigation.

Purpose of the Study:

  • To assess the reproducibility of EVH testing in recreational athletes.
  • To evaluate the reliability of EVH for diagnosing EIB in this population.

Main Methods:

  • 32 recreational athletes underwent two EVH challenges separated by 14-21 days.
  • Spirometry and impulse oscillometry were measured pre- and post-EVH.
  • Training load was kept consistent between testing sessions.

Main Results:

  • No significant differences in pre-challenge lung function or maximal change in FEV1 (ΔFEV1max) were found between visits.
  • Test-retest ΔFEV1max showed good correlation (ICC=0.81) but poor diagnostic reliability (only 7/11 athletes positive at both visits).
  • Wide limits of agreement for ΔFEV1max and similar findings for impulse oscillometry indicated poor reproducibility.

Conclusions:

  • EVH testing demonstrated poor clinical reproducibility for diagnosing EIB in recreational athletes.
  • A single EVH test may not be sufficient to confirm or refute EIB.
  • Performing multiple EVH tests is recommended for diagnosing mild or borderline EIB.