Chest
Volume 105, Issue 3, March 1994, Pages 667-672
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Clinical Investigations: Asthma/Bronchodilators
Eucapnic Voluntary Hyperventilation as a Bronchoprovocation Technique: Comparison With Methacholine Inhalation in Asthmatics

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Methacholine inhalation challenge (MIC) is probably the most widely used and best standardized test for nonspecific bronchoprovocation challenge (BPC). There has been increasing interest in developing “physical” stimuli such as eucapnic voluntary hyperventilation (EVH) with dry gas to assess airway hyperreactivity (AHR), because of inherent problems with using a pharmacologic agent in epidemiologic surveys. To our knowledge, no studies exist that compare MIC with EVH in known asthmatics. We conducted a prospective, randomized, crossover trial with a group of subjects (n = 16) who met the American Thoracic Society definition of asthma with these objectives: (1) to compare the sensitivity of EVH with MIC; (2) to compare the quantitative response of one test with the response to the other challenge; and (3) to correlate the response of both tests with symptoms, serum IgE levels, and serum eosinophil counts. We found that (1) EVH was positive in 75 percent of cases and MIC was positive in 81 percent of cases; one subject reacted to EVH but not to MIC and vice-versa. (2) The quantitative response to one test correlated with the response to the other test (r = − 0.60, p = 0.01). (3) There was a correlation between severity of asthma symptoms and the response to EVH (r = 0.62; p = 0.01), but not to MIC. (4) Response to MIC (log PD20), but not EVH, correlated with serum IgE level (r = − 0.53, p = 0.04). We suggest that EVH may be used for the initial assessment of AHR in the evaluation of asthma. Eucapnic voluntary hyperventilation is a sensitive measure of AHR and it correlates well with symptoms. Furthermore, though these points were not addressed in our study, it is more physiologic than MIC, and it is easy and less expensive to perform.

Section snippets

Subject Population

Study subjects were identified by reviewing pulmonary clinic records, as well as by examining new referrals to the clinic. In order to meet our entry criteria to be labeled as “asthmatic,” subjects had to meet the definition proposed by the ATS as previously mentioned.1 That is to say, they must have had clinical and/or physiologic evidence of reversible airway obstruction at some point, without any other obvious cause (eg, reactive airways disease after an upper respiratory tract infection).

Descriptive Statistics

Descriptive statistics for the study population are presented in Table 1 (data expressed as arithmetic percent) admitted to worsening of their symptoms upon exercise. The subjects were only mildly obstructed prechallenge and there was no difference in baseline spirometry between the first and second days of testing (paired t test: FVC p = 0.44, FEV1 p = 0.48). The maximum response to EVH in terms of decline in FEV1 was noted immediately postchallenge in 4 subjects (25 percent), 5 min

DISCUSSION

In 1977, Strauss et al13 found that in asthmatic subjects, inhalation of cold air accentuated the bronchoconstrictor response to exercise. Deal and his associates9 further refined the technique of isocapnic hyperventilation with cold dry air and demonstrated that this technique was a very sensitive and highly specific means of detecting AHR. Furthermore, there was no overlap between normal and asthmatic subjects in their responsiveness to the challenge.9 The greatest postchallenge decline in FEV

ACKNOWLEDGMENTS

The authors gratefully acknowledge S.F.C. James Godville and S.S.G. Martin Koehnlein for their technical assistance and expertise. We also acknowledge our indebtedness to Ms. Robin Howard for her invaluable help with statistical analyses.

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    The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army, Uniformed Services University of the Health Sciences, or the Department of Defense. The research was approved by the Walter Reed Army Medical Center Clinical Investigation Committee and the Human Use Committee/Institutional Review Board. All subjects enrolled into the study voluntarily agreed to participate and gave written informed consent. Funding for the study was supported by the Department of Clinical Investigation protocol 1752.

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