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Diagnosing exercise-induced bronchoconstriction with eucapnic voluntary hyperpnea: is one test enough?
J Allergy Clin Immunol Pract. 2015 Mar-Apr; 3(2):243-9.JA

Abstract

BACKGROUND

In athletic individuals, a secure diagnosis of exercise-induced bronchoconstriction (EIB) is dependent on objective testing. Indirect bronchoprovocation testing is often used in this context and eucapnic voluntary hyperpnea (EVH) testing is recommended for this purpose, yet the short-term reproducibility of EVH is yet to be appropriately established.

OBJECTIVE

The aim of this study was to evaluate the reproducibility of EVH in a cohort of recreational athletes.

METHODS

A cohort of recreational athletes (n = 32) attended the laboratory on two occasions to complete an EVH challenge, separated by a period of 14 or 21 days. Spirometry and impulse oscillometry was performed before and after EVH. Training load was maintained between visits.

RESULTS

Prechallenge lung function was similar at both visits (P > .05). No significant difference was observed in maximum change in FEV1 (ΔFEV1max) after EVH between visits (P > .05), and test-retest ΔFEV1max was correlated (intraclass correlation coefficient = 0.81; r(2) = 0.66; P = .001). Poor diagnostic reliability was observed between tests; 11 athletes were diagnosed with EIB (on the basis of ΔFEV1max ≥10%) at visit 1 and at visit 2. However, only 7 athletes were positive at both visits. Although there was a small mean difference in ΔFEV1max between tests (-0.6%), there were wide limits of agreement (-10.7% to 9.5%). Likewise, similar results were observed for impulse oscillometry between visits.

CONCLUSIONS

In a cohort of recreational athletes, EVH demonstrated poor clinical reproducibility for the diagnosis of EIB. These findings highlight a need for caution when confirming or refuting EIB on the basis of a single indirect bronchoprovocation challenge. When encountering patients with mild or borderline EIB, we recommend that more than one EVH test is performed to exclude or confirm a diagnosis.

Authors+Show Affiliations

Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom.Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom.Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom; Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom. Electronic address: j.hull@rbht.nhs.uk.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25609322

Citation

Price, Oliver J., et al. "Diagnosing Exercise-induced Bronchoconstriction With Eucapnic Voluntary Hyperpnea: Is One Test Enough?" The Journal of Allergy and Clinical Immunology. in Practice, vol. 3, no. 2, 2015, pp. 243-9.
Price OJ, Ansley L, Hull JH. Diagnosing exercise-induced bronchoconstriction with eucapnic voluntary hyperpnea: is one test enough? J Allergy Clin Immunol Pract. 2015;3(2):243-9.
Price, O. J., Ansley, L., & Hull, J. H. (2015). Diagnosing exercise-induced bronchoconstriction with eucapnic voluntary hyperpnea: is one test enough? The Journal of Allergy and Clinical Immunology. in Practice, 3(2), 243-9. https://doi.org/10.1016/j.jaip.2014.10.012
Price OJ, Ansley L, Hull JH. Diagnosing Exercise-induced Bronchoconstriction With Eucapnic Voluntary Hyperpnea: Is One Test Enough. J Allergy Clin Immunol Pract. 2015 Mar-Apr;3(2):243-9. PubMed PMID: 25609322.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnosing exercise-induced bronchoconstriction with eucapnic voluntary hyperpnea: is one test enough? AU - Price,Oliver J, AU - Ansley,Les, AU - Hull,James H, Y1 - 2014/11/25/ PY - 2014/07/01/received PY - 2014/10/21/revised PY - 2014/10/24/accepted PY - 2015/1/23/entrez PY - 2015/1/23/pubmed PY - 2015/12/15/medline KW - Airway dysfunction KW - Athletes KW - Eucapnic voluntary hyperpnea KW - Exercise-induced bronchoconstriction KW - Indirect bronchoprovocation testing KW - Reproducibility SP - 243 EP - 9 JF - The journal of allergy and clinical immunology. In practice JO - J Allergy Clin Immunol Pract VL - 3 IS - 2 N2 - BACKGROUND: In athletic individuals, a secure diagnosis of exercise-induced bronchoconstriction (EIB) is dependent on objective testing. Indirect bronchoprovocation testing is often used in this context and eucapnic voluntary hyperpnea (EVH) testing is recommended for this purpose, yet the short-term reproducibility of EVH is yet to be appropriately established. OBJECTIVE: The aim of this study was to evaluate the reproducibility of EVH in a cohort of recreational athletes. METHODS: A cohort of recreational athletes (n = 32) attended the laboratory on two occasions to complete an EVH challenge, separated by a period of 14 or 21 days. Spirometry and impulse oscillometry was performed before and after EVH. Training load was maintained between visits. RESULTS: Prechallenge lung function was similar at both visits (P > .05). No significant difference was observed in maximum change in FEV1 (ΔFEV1max) after EVH between visits (P > .05), and test-retest ΔFEV1max was correlated (intraclass correlation coefficient = 0.81; r(2) = 0.66; P = .001). Poor diagnostic reliability was observed between tests; 11 athletes were diagnosed with EIB (on the basis of ΔFEV1max ≥10%) at visit 1 and at visit 2. However, only 7 athletes were positive at both visits. Although there was a small mean difference in ΔFEV1max between tests (-0.6%), there were wide limits of agreement (-10.7% to 9.5%). Likewise, similar results were observed for impulse oscillometry between visits. CONCLUSIONS: In a cohort of recreational athletes, EVH demonstrated poor clinical reproducibility for the diagnosis of EIB. These findings highlight a need for caution when confirming or refuting EIB on the basis of a single indirect bronchoprovocation challenge. When encountering patients with mild or borderline EIB, we recommend that more than one EVH test is performed to exclude or confirm a diagnosis. SN - 2213-2201 UR - https://www.unboundmedicine.com/medline/citation/25609322/Diagnosing_exercise_induced_bronchoconstriction_with_eucapnic_voluntary_hyperpnea:_is_one_test_enough L2 - https://linkinghub.elsevier.com/retrieve/pii/S2213-2198(14)00509-1 DB - PRIME DP - Unbound Medicine ER -