The feasibility of eucapnic voluntary hyperpnoea for the diagnosis of exercise-induced bronchoconstriction in a community pulmonary practice.

Document Type

Article

Publication Date

10-1-2020

Publication Title

The Journal of asthma : official journal of the Association for the Care of Asthma

Keywords

Exercise induced; diagnostics; quality of life

Abstract

OBJECTIVE: Exercise-induced bronchoconstriction (EIB) is a common condition and is typically treated empirically based on symptoms alone. However, symptoms of EIB are typically nonspecific. Objective testing with eucapnic voluntary hyperpnea (EVH) is a sensitive and specific method to diagnose EIB and may suggest alternative etiologies such as exercise-induced laryngeal obstruction (EILO). To this point, EVH has been primarily utilized in large academic centers and in elite athletes. We intend to discuss the feasibility and clinical application of utilizing EVH to diagnose EIB in a community-based pulmonary practice.

METHODS: Retrospective analysis of 62 patients who completed EVH at The Oregon Clinic Pulmonary Clinic. Patients with inspiratory flow volume loop flattening or clinical symptoms were assessed by otolaryngology for evidence of EILO.

RESULTS: 61 of 62 patients were included in the final analysis. 52 of 61 patients (85%) achieved an interpretable test with a maximum voluntary ventilation (MVV) >60%. There was no difference in baseline spirometry or patient characteristics between those who were able to reach an MVV >60% and those who did not. 14 (23%) patients were diagnosed with EIB, 18 (30%) with EILO, and 4 (7%) were diagnosed with both EIB and EILO. Only 1 patient had a non-diagnostic evaluation with MVV

CONCLUSIONS: EVH is a feasible diagnostic modality to evaluate for EIB in a community pulmonary practice and may suggest alternative conditions such as EILO. Accurate diagnosis is paramount to prescribing proper therapy, decreasing inappropriate medication use, and relieving exercise-induced symptoms.

Department

Pulmonary Medicine

Department

Internal Medicine

Department

Critical Care Medicine

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