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

James H Hull, Les Ansley, Oliver J Price, John W Dickinson, Matteo Bonini, James H Hull, Les Ansley, Oliver J Price, John W Dickinson, Matteo Bonini

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.

Figures

Fig. 1
Fig. 1
Eucapnic voluntary hyperpnea protocol and test recommendations. EVH eucapnic voluntary hyperpnea, FEV1 forced expiratory volume in 1 s, MVV maximum voluntary ventilation
Fig. 2
Fig. 2
Photograph depicting the eucapnic voluntary hyperpnea challenge set-up
Fig. 3
Fig. 3
Degree of bronchoconstriction after a eucapnic voluntary hyperpnea challenge in relation to the FEV1 % fall compared with baseline and the ventilation rate maintained during the test FEV1 forced expiratory volume in 1 s, VE minute ventilation

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