Allergy Asthma Immunol Res.  2017 May;9(3):229-236. 10.4168/aair.2017.9.3.229.

Is Performance of a Modified Eucapnic Voluntary Hyperpnea Test in High Ventilation Athletes Reproducible?

• Kennedy MD
• Steinback
• Skow R
• Parent EC

• KMID: 2371723
• DOI: http://doi.org/10.4168/aair.2017.9.3.229

Abstract

PURPOSE
Exercise-induced bronchoconstriction (EIB) is common in "high ventilation" athletes, and the Eucapnic Voluntary Hyperpnea (EVH) airway provocation test is the standard EIB screen. Although the EVH test is widely used, the in-test performance in high ventilation athletes as well as the reproducibility of that performance has not been determined. Reproducibility of pre- and post-test spirometry and self-reported atopy/cough was also examined.
METHODS
High ventilation athletes (competitive swimmers; n=11, 5 males) completed an atopy/cough questionnaire and EVH testing (operator controlled FiCOâ‚‚) on 2 consecutive days.
RESULTS
Swimmers achieved 85%±9% and 87%±9% of target FEV1 volume on days 1 and 2, respectively, (P=0.45; ICC 0.57 [0.00-0.86]) resulting in a total ventilation of 687 vs 684 L [P=0.89, ICC 0.89 (0.65-0.97]) equating to 83%±8% and 84%±9% of predicted total volume (ICC 0.54 [0.00-0.85]) between days 1 and 2. FiCOâ‚‚ required to maintain eucapnic conditions was 2.5%. Pre-test FEV1 was less on day 2 (P=0.04; ICC >0.90). Day 1 to 2 post-test FEV1 was not different, and 4 swimmers were EIB positive (>10% fall in pre-post FEV1) on day 1 (3 on day 2).
CONCLUSIONS
EVH in-test performance is reproducible however required less FiCO₂ than standard protocol and the swimmers under-ventilated by 125 and 139 L/min for days 1 and 2, respectively. How this affects EIB diagnosis remains to be determined; however, our results indicate a post-test FEV1 fall of ≥20% may be recommended as the most consistent diagnostic criterion.

Keyword

Exercise-Induced Bronchospasm; airway hyper-responsiveness; cough; swimming

MeSH Terms

Asthma, Exercise-Induced
Athletes*
Bronchoconstriction
Cough
Diagnosis
Humans
Respiratory Hypersensitivity
Spirometry
Swimming
Ventilation*

Figure

• 

  Fig. 1 Level of agreement of the measure “% of Target FEV1” using Bland Altman plots for the analysis of the agreement between days 1 and 2 for each minute of the EVH test. Percent of target FEV1 was used to provide normalized score that account for anthropometric differences in participants. For each minute, the limits of agreement (LOA) are shown as 95% confidence intervals (Panel A=min 1; Panel B=min 2; Panel C=min 3; Panel D=min 4; Panel E=min 5; Panel F=min 6). The distribution of average % of Target FEV1 (combined days 1 and 2) for each participant for each minute of the EVH test is also shown.

• 

  Fig. 2 Delta day 1-2 pos t-test FEV1 changes in percent for each participant at each time point (post, 5 min, 10 min, and 20 min).

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