Alternatives to exercise challenge for the objective assessment of exercise-induced bronchospasm: eucapnic voluntary hyperpnoea and the osmotic challenge tests

Porsbjerg, Celeste; Brannan, John D.

doi:10.1183/18106838.0701.053

Cited by 9 publications

(5 citation statements)

References 47 publications

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“…A positive response is documented as a 10–15% fall in FEV 1 and the severity of the response is determined by the degree of the fall in FEV 1 . In known asthmatics, large falls in FEV 1 can be observed when using these tests so for clinical use they are often confined to individuals who are suspected of having EIB with normal lung function (Brannan et al, 1998; Porsbjerg and Brannan, 2010). These tests differ from the dose-response challenges such as the osmotic stimuli or AMP where, like the direct challenges, the stimulus is given in increasing doses and changes in FEV 1 are documented until a 15% (mannitol, hypertonic saline) or 20% (AMP) fall or no target response is obtained by the maximum dose.…”

Section: Indirect Bronchial Provocation Testsmentioning

confidence: 99%

Airway Hyperresponsiveness in Asthma: Mechanisms, Clinical Significance, and Treatment

Brannan¹,

Lougheed²

2012

Front. Physio.

122

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Airway hyperresponsiveness (AHR) and airway inflammation are key pathophysiological features of asthma. Bronchial provocation tests (BPTs) are objective tests for AHR that are clinically useful to aid in the diagnosis of asthma in both adults and children. BPTs can be either “direct” or “indirect,” referring to the mechanism by which a stimulus mediates bronchoconstriction. Direct BPTs refer to the administration of pharmacological agonist (e.g., methacholine or histamine) that act on specific receptors on the airway smooth muscle. Airway inflammation and/or airway remodeling may be key determinants of the response to direct stimuli. Indirect BPTs are those in which the stimulus causes the release of mediators of bronchoconstriction from inflammatory cells (e.g., exercise, allergen, mannitol). Airway sensitivity to indirect stimuli is dependent upon the presence of inflammation (e.g., mast cells, eosinophils), which responds to treatment with inhaled corticosteroids (ICS). Thus, there is a stronger relationship between indices of steroid-sensitive inflammation (e.g., sputum eosinophils, fraction of exhaled nitric oxide) and airway sensitivity to indirect compared to direct stimuli. Regular treatment with ICS does not result in the complete inhibition of responsiveness to direct stimuli. AHR to indirect stimuli identifies individuals that are highly likely to have a clinical improvement with ICS therapy in association with an inhibition of airway sensitivity following weeks to months of treatment with ICS. To comprehend the clinical utility of direct or indirect stimuli in either diagnosis of asthma or monitoring of therapeutic intervention requires an understanding of the underlying pathophysiology of AHR and mechanisms of action of both stimuli.

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Section: Indirect Bronchial Provocation Testsmentioning

confidence: 99%

Airway Hyperresponsiveness in Asthma: Mechanisms, Clinical Significance, and Treatment

Brannan¹,

Lougheed²

2012

Front. Physio.

122

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“…Eucapnic voluntary hyperpnoea (EVH) with dry air [i.e. the most sensitive bronchial provocation test to identify EIB in elite athletes ] or mannitol challenge [i.e. a suitable alternative to EVH to identify EIB in summer athletes ] was conducted in a group of English professional soccer players.…”

mentioning

confidence: 99%

Misdiagnosis of exercise‐induced bronchoconstriction in professional soccer players

Ansley

Kippelen

Dickinson

et al. 2011

Allergy

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“…These include bronchodilator reversibility testing, eucapnic voluntary hyperpnoea, methacholine challenge testing, laboratory and field exercise testing and saline or dry powder mannitol challenges [44,52]. A secure diagnosis then depends on confirmatory investigation (proposed assessment algorithm is presented in Figure 2).…”

Section: Diagnostic Guidelinesmentioning

confidence: 99%

Advances in the diagnosis of exercise-induced bronchoconstriction

Price

Hull

Ansley

2014

Expert Review of Respiratory Medicine

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Alternatives to exercise challenge for the objective assessment of exercise-induced bronchospasm: eucapnic voluntary hyperpnoea and the osmotic challenge tests

Cited by 9 publications

References 47 publications

Airway Hyperresponsiveness in Asthma: Mechanisms, Clinical Significance, and Treatment

Airway Hyperresponsiveness in Asthma: Mechanisms, Clinical Significance, and Treatment

Misdiagnosis of exercise‐induced bronchoconstriction in professional soccer players

Advances in the diagnosis of exercise-induced bronchoconstriction

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