Eucapnic Voluntary Hyperpnea: Gold Standard for Diagnosing Exercise-Induced Bronchoconstriction in Athletes?

Abstract

In athletes, a secure diagnos is of exercise-induced bronchoconstriction (EIB) is dependent on objective testing. Evaluating spirometric indices of airflow before and following an exercise bout is intuitively the optimal means for the diagnosis; however, this approach is recognized as having several key limitations. Accordingly, alternative indirect bronchoprovocation tests have been recommended as surrogate means for obtaining a diagnosis of EIB. Of these tests, it is often argued that the eucapnic voluntary hyperpnea (EVH) challenge represents the ‘gold standard’. This article provides a state-of-the-art review of EVH, including an overview of the test methodology and its interpretation. We also address the performance of EVH against the other functional and clinical approaches commonly adopted for the diagnosis of EIB. The published evidence supports a key role for EVH in the diagnostic algorithm for EIB testing in athletes. However, its wide sensitivity and specificity and poor repeatability preclude EVH from being termed a ‘gold standard’ test for EIB.Electronic supplementary materialThe online version of this article (doi:10.1007/s40279-016-0491-3) contains supplementary material, which is available to authorized users.

Impact of detecting and treating exercise-induced bronchoconstriction in elite footballers

“…The aim of this work was to address these deficiencies by using robust objective tests to provide a comprehensive assessment of the impact of EIB in professional football players by: 1) determining the prevalence of EIB in elite footballers; 2) assessing the impact of appropriate therapy on airway inflammation and EIB control; and 3) investigating the effect of treating players with EIB on exercise performance. In order to achieve this aim with a standardised and widely accepted approach, we utilised the bronchoprovocation methodology of eucapnic voluntary hyperpnoea (EVH) [ 16 ] testing to establish the presence of airway dysfunction and EIB. We hypothesised that EIB would be highly prevalent and that initiation of standard asthma therapy would be beneficial for airway health, as assessed by physiological measures of airway hyperreactivity and inflammation, and potentially for exercise performance.…”

Efecto agudo del ejercicio físico de intensidad moderada sobre las variables espirométricas en sujetos asmáticos broncodilatados. Prueba piloto

“…Lo anterior hace pensar en la necesidad de generar futuras investigaciones que permitan comprender mejor el efecto de diferentes intensidades y duraciones del ejercicio sobre la capacidad de respuesta de las vías respiratorias, teniendo en cuenta la gravedad del asma, el sexo y la condición física de los evaluados (34,35), aspectos que no fueron tenidos en cuenta en este estudio, siendo considerados como parte de sus limitaciones, además del pequeño tamaño de muestra utilizado, lo que hace que los resultados no sean extrapolables a otras realidades.…”

Anti-doping Policy, Therapeutic Use Exemption and Medication Use in Athletes with Asthma: A Narrative Review and Critical Appraisal of Current Regulations

“…Despite these findings, the diagnostic test currently endorsed by the IOC-MC (i.e. indirect bronchoprovocation via eucapnic voluntary hyperpnoea) [ 76 ] remains under-utilised and largely overlooked [ 68 ].…”