Background: Exercise-induced bronchoconstriction (EIB) describes the phenomenon of

275Running title: Reproducibility of eucapnic voluntary hyperpnea. Price et al. 2Funding statement: Nil relevant. Highlights What is already known about this topic?Indirect bronchoprovocation testing, specifically eucapnic voluntary hyperpnoea (EVH) is currently recommended for the diagnosis of exercise-induced bronchoconstriction (EIB).However the clinical reproducibility of this methodology has yet to be appropriately established; presenting a potential for misdiagnosis. What does this article add to our knowledge?This article highlights the need for caution when making a diagnosis of EIB based on a solitary EVH assessment to reduce the potential for misdiagnosis. Indeed when encountering patients with a mild or borderline reduction in lung function post challenge, we recommend that more than one EVH test is performed to exclude or confirm a diagnosis of EIB. How does this study impact current management guidelines?The application of treatment for EIB in recreational athletes should only be initiated when a diagnosis has been correctly established. Price et al. 3ABSTRACT Background: In athletic individuals, a secure diagnosis of exercise-induced

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.Electronic supplementary materialThe online version of this article (doi:10.1007/s40279-016-0491-3) contains supplementary material, which is available to authorized users.

In people recovering from COVID-19, there is concern regarding potential long-term pulmonary sequelae and associated impairment of functional capacity. Data published thus far indicate that spirometric indices appear to be generally well preserved, but that a defect in diffusing capacity (DLco) is a prevalent abnormality identified on follow-up lung function; present in 20-30% of those with mild to moderate disease and 60% in those with severe disease. Reductions in total lung capacity were commonly reported. Functional capacity is also often impaired, with data now starting to emerge detailing walk test and cardiopulmonary exercise test outcome at follow-up. In this review, we evaluate the published evidence in this area, to summarise the impact of COVID-19 infection on pulmonary function and relate this to the clinico-radiological findings and disease severity.