The Journal of Allergy and Clinical Immunology: In Practice
Original ArticleDiagnosing Exercise-Induced Bronchoconstriction With Eucapnic Voluntary Hyperpnea: Is One Test Enough?
Section snippets
Study population
Thirty-six recreational athletes (training 6 ± 1 h/wk; men: n = 31) from various sporting disciplines—endurance (n = 22; runners, cyclists, and triathletes), intermittent high-intensity (n = 11; soccer, rugby, and hockey), and nonendurance (n = 3; weightlifters)—were recruited to take part in the study. All subjects were nonsmokers, free from respiratory, cardiovascular, metabolic, and psychiatric disease, and any other significant medical condition except mild asthma. Six subjects had a
Results
Thirty-two athletes (men: n = 28) completed the study. One athlete was excluded at the initial visit on the basis of resting airway obstruction, and three athletes were excluded because of illness. Subjects' characteristics are presented in Table I.
Discussion
In a cohort of recreational athletes, EVH demonstrates poor diagnostic test-retest reproducibility over a short-term period of assessment. This finding has implications for the clinical utility and application of EVH as a bronchoprovocation challenge in the diagnosis of EIB, specifically when it is used in a population of recreational athletes with mild reductions in lung function after a challenge. Moreover, it highlights the need for caution when EVH is used as a screening tool for EIB in a
Conclusions
EVH is currently recommended as a key bronchoprovation challenge for the diagnosis of EIB in athletes. This study demonstrates poor diagnostic reproducibility over a short-term period of assessment in recreational athletes, when a cutoff value of 10% or more fall in FEV1 is employed. Accordingly, the findings indicate the need for caution when clinicians make a diagnosis on the basis of a solitary EVH assessment and suggest that further assessment and/or surveillance be considered. Therefore,
References (45)
- et al.
Exercise-induced bronchoconstriction in athletes*
Chest
(2005) - et al.
Exercise in elite summer athletes: challenges for diagnosis
J Allergy Clin Immunol
(2002) - et al.
Eucapnic voluntary hyperventilation as a bronchoprovocation technique
Chest
(1996) - et al.
Statistical methods for assessing agreement between two methods of clinical measurement
Lancet
(1986) - et al.
Exercise-induced asthma: is it the right diagnosis in elite athletes?
J Allergy Clin Immunol
(2000) - et al.
Exercise and other indirect challenges to demonstrate asthma or exercise-induced bronchoconstriction in athletes
J Allergy Clin Immunol
(2008) - et al.
Airway hyperresponsiveness in elite swimmers: is it a transient phenomenon?
J Allergy Clin Immunol
(2011) - et al.
Airway narrowing measured by spirometry and impulse oscillometry following room temperature and cold temperature exercise
Chest
(2005) - et al.
Interpretation of eucapnic voluntary hyperventilation in the diagnosis of asthma
Chest
(1995) - et al.
Respiratory health of elite athletes–preventing airway injury: a critical review
Br J Sports Med
(2012)
Airway dysfunction in elite athletes–an occupational lung disease?
Allergy
The impact of exercise-induced bronchoconstriction on athletic performance: a systematic review
Sports Med
Misdiagnosis of exercise-induced bronchoconstriction in professional soccer players
Allergy
Practical approach to exercise-induced bronchoconstriction in athletes
Prim Care Respir J
Self-reported symptoms and exercise-induced asthma in the elite athlete
Med Sci Sports Exerc
An official American Thoracic Society clinical practice guideline: exercise-induced bronchoconstriction
Am J Respir Crit Care Med
Pathogenesis, prevalence, diagnosis, and management of exercise-induced bronchoconstriction: a practice parameter
Ann Allergy Asthma Immunol
Advances in the diagnosis of exercise-induced bronchoconstriction
Expert Rev Respir Med
Reproducibility of the airway response to an exercise protocol standardized for intensity, duration, and inspired air conditions, in subjects with symptoms suggestive of asthma
Respir Res
Prevalence of exercise-induced bronchospasm in a cohort of varsity college athletes
Med Sci Sports Exerc
Diagnosis of exercise-induced bronchoconstriction: eucapnic voluntary hyperpnoea challenges identify previously undiagnosed elite athletes with exercise-induced bronchoconstriction
Br J Sports Med
Cited by (33)
Work Group Report: Perspectives in Diagnosis and Management of Exercise-Induced Bronchoconstriction in Athletes
2020, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :Other tests that have been evaluated include fractional exhaled nitric oxide measurement, but it is not currently standard of care in diagnosing EIB in children or adults.17 Reproducibility is problematic, and there can be variation between airway response to exercise compared with EVH and mannitol and even with the same test in the same subject.33-36 The response on initial challenge has a 62% sensitivity of predicting EIB on subsequent challenge.34,35
Testing for Exercise-Induced Bronchoconstriction
2018, Immunology and Allergy Clinics of North AmericaCitation Excerpt :There is no single test that can identify all individuals who have EIB. There can be variations in the airway response with exercise compared with EVH and mannitol, as well as evidence of variation with the same test in an individual.18,23,28,29 It has been reported that the response to exercise on an initial challenge only has a 62% sensitivity of predicting EIB on repeat challenge.23,28
Exercise-induced bronchoconstriction update—2016
2016, Journal of Allergy and Clinical ImmunologyBronchial Provocation Testing for the Identification of Exercise-Induced Bronchoconstriction
2020, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :Possible reasons are that (1) the exercise test in the laboratory may not be sufficiently vigorous to require a ventilation rate to cause adequate airway dehydration57; (2) it is not always possible to control water content of inspired air57; and (3) airway irritants (eg, airborne allergens, traffic-related pollutants, and chlorination by-products in swimming pools) can enhance EIB in the field.58 In addition, in individuals with an FEV1 fall around the 10% threshold, there can be a variation in the airway response when multiple tests are performed.56,59 Although this is a problem diagnostically, it also suggests that, in these individuals, EIB is likely to be mild.
Exercise-induced bronchoconstriction, allergy and sports in children
2024, Italian Journal of Pediatrics
No funding was received for this work.
Conflicts of interest: The authors declare that they have no relevant conflicts of interest.