title: Diagnosing exercise-induced bronchoconstriction with eucapnic voluntary hyperpnea: is one test enough?
abstract: BACKGROUND
  In athletic individuals, a secure diagnosis of exercise-induced bronchoconstriction (EIB) is dependent on objective testing. Indirect bronchoprovocation testing is often used in this context and eucapnic voluntary hyperpnea (EVH) testing is recommended for this purpose, yet the short-term reproducibility of EVH is yet to be appropriately established.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the reproducibility of EVH in a cohort of recreational athletes.
  
  
  METHODS
  A cohort of recreational athletes (n = 32) attended the laboratory on two occasions to complete an EVH challenge, separated by a period of 14 or 21 days. Spirometry and impulse oscillometry was performed before and after EVH. Training load was maintained between visits.
  
  
  RESULTS
  Prechallenge lung function was similar at both visits (P > .05). No significant difference was observed in maximum change in FEV1 (ΔFEV1max) after EVH between visits (P > .05), and test-retest ΔFEV1max was correlated (intraclass correlation coefficient = 0.81; r(2) = 0.66; P = .001). Poor diagnostic reliability was observed between tests; 11 athletes were diagnosed with EIB (on the basis of ΔFEV1max ≥10%) at visit 1 and at visit 2. However, only 7 athletes were positive at both visits. Although there was a small mean difference in ΔFEV1max between tests (-0.6%), there were wide limits of agreement (-10.7% to 9.5%). Likewise, similar results were observed for impulse oscillometry between visits.
  
  
  CONCLUSIONS
  In a cohort of recreational athletes, EVH demonstrated poor clinical reproducibility for the diagnosis of EIB. These findings highlight a need for caution when confirming or refuting EIB on the basis of a single indirect bronchoprovocation challenge. When encountering patients with mild or borderline EIB, we recommend that more than one EVH test is performed to exclude or confirm a diagnosis.
authors.affiliation: Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Price
authors.affiliation: Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom.
authors.forename: Les
authors.initials: L
authors.lastname: Ansley
authors.affiliation: Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom; Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom. Electronic address: j.hull@rbht.nhs.uk.
authors.forename: James H
authors.initials: JH
authors.lastname: Hull
mesh_terms: D000328:Adult; D001985:Bronchial Provocation Tests; D016084:Bronchoconstriction; D015444:Exercise / Q000502:physiology*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D009991:Oscillometry; D015203:Reproducibility of Results; D055815:Young Adult
keywords: Airway dysfunction; Athletes; Eucapnic voluntary hyperpnea; Exercise-induced bronchoconstriction; Indirect bronchoprovocation testing; Reproducibility