Diagnosing Exercise-Induced Bronchoconstriction With Eucapnic Voluntary Hyperpnea: Is One Test Enough?

Abstract

275Running title: Reproducibility of eucapnic voluntary hyperpnea. Price et al. 2Funding statement: Nil relevant. Highlights What is already known about this topic?Indirect bronchoprovocation testing, specifically eucapnic voluntary hyperpnoea (EVH) is currently recommended for the diagnosis of exercise-induced bronchoconstriction (EIB).However the clinical reproducibility of this methodology has yet to be appropriately established; presenting a potential for misdiagnosis. What does this article add to our knowledge?This article highlights the need for caution when making a diagnosis of EIB based on a solitary EVH assessment to reduce the potential for misdiagnosis. Indeed when encountering patients with a mild or borderline reduction in lung function post challenge, we recommend that more than one EVH test is performed to exclude or confirm a diagnosis of EIB. How does this study impact current management guidelines?The application of treatment for EIB in recreational athletes should only be initiated when a diagnosis has been correctly established. Price et al. 3ABSTRACT Background: In athletic individuals, a secure diagnosis of exercise-induced

Reproducibility of the bronchoconstrictive response to eucapnic voluntary hyperpnoea

“…Conversely, in the present study the post-EVH fall in FEV 1 was highly reproducible for all HIB-positive participants, including those with mild HIB (Figures 1 and 2). Although the reasons for this inter-study discrepancy remain unclear, only 6 of 32 participants studied by Price et al 26 had physician diagnosed asthma and the post-EVH fall in FEV 1 (10  8%) was much smaller than in the present study (27%). Our data show that in recreationally active males with physician diagnosed asthma the degree of HIB elicited by EVH is reproducible for up to 70 days irrespective of HIB severity.…”

“…Price et al 26 have raised concerns regarding the reproducibility of HIB in individuals demonstrating a mild or borderline (10%) post-EVH fall in FEV 1 , which may result in misdiagnosis of EIB. Conversely, in the present study the post-EVH fall in FEV 1 was highly reproducible for all HIB-positive participants, including those with mild HIB (Figures 1 and 2).…”

Urinary excretion of lipid mediators in response to repeated eucapnic voluntary hyperpnea in asthmatic subjects

“…Concerning the repeatability of the EVH challenge, BlandAltman analysis (7) revealed a high variability between challenges, which is in line with findings by Price and colleagues (30). Considering that the between-study day difference for several subjects was Ͼ10%, the question arises about the usability of the EVH challenge as a predictive tool in the diagnosis of EIB.…”

Is there a need to improve asthma diagnosis in young athletes?

“…However, when conducted in young athletes, the target ventilation of 85% of maximum voluntary ventilation may need adjustment [3]. Further, as for exercise testing, two EVH tests may be required [22]. Due to its high potency, EVH is not recommended in athletes with a history of severe clinical asthma; for those, the progressive osmotic challenge tests (i.e.…”