Eucapnic voluntary hyperpnea challenge can support management of exercise‐induced bronchoconstriction in elite swimmers

Abstract

Introduction This study investigated the use of eucapnic voluntary hyperpnea (EVH) to monitor efficacy of pharmacological therapy in elite swimmers with exercise‐induced bronchoconstriction (EIB). Secondly, it evaluated the long‐term test‐retest repeatability of EVH in this population. Methods Twenty‐seven elite international swimmers were included in this retrospective analysis of comprehensive respiratory assessments. Following an initial “withheld‐therapy” assessment, athletes with EIB had been prescribed appropriate pharmacological therapy and returned twelve months later for a follow‐up assessment to monitor EIB protection afforded by treatment. EIB‐negative athletes had returned to confirm initial diagnosis, as were still reporting persistent respiratory symptoms. Athletes were retrospectively grouped into either “Therapy Adherent Group” (n = 12) or “Repeatability Group” (discontinued therapy at follow‐up or EIB‐negative, n = 15). Results Greatest fall in forced expiratory volume in 1 second (ΔFEV1max) was significantly lower following therapy adherence (−11.8 ± 3.8%) compared to initial assessment (−24.0 ± 11.3%; P < .01). “Repeatability Group” ΔFEV1max did not differ significantly between initial assessment (−13.1 ± 4.5%) and follow‐up (−12.3 ± 5.6%; P = .32), and showed good agreement (0.6%; −5.9%, 7.1%). Conclusion A follow‐up assessment utilizing EVH is useful in the management of EIB and shows good test‐retest repeatability over twelve months in elite swimmers who discontinue treatment or are EIB‐negative.

Diagnostic approach to lower airway dysfunction in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus on ‘acute respiratory illness in the athlete’

“…These findings aligns with previous guideline documents, recommending EVH as the ‘gold standard’ to identify EIB in athletes 10 54 55. There does remain some debate regarding the test–retest repeatability, with some studies reporting relatively poor short-term repeatability, especially in the context of mild or borderline EIB,54 56 while others have shown better short-term and long-term test–retest validity for EVH 57 58…”

Prevalence of lower airway dysfunction in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus group on ‘acute respiratory illness in the athlete’

“…It is also important to acknowledge that while some groups have previously reported good test–retest repeatability following objective testing in athletes,95 96 others have highlighted that a single bronchial provocation challenge (ie, exercise and EVH) has the potential to result in misdiagnosis (particularly in athletes with mild severity disease or a borderline diagnosis) 97 98. In this respect, none of the included studies performed multiple assessments (ie, in/out of season testing) in the same athlete to confirm or refute a diagnosis.…”

Fractional exhaled nitric oxide in the assessment of exercise‐induced bronchoconstriction: A multicenter retrospective analysis of UK‐based athletes

“…Finally, although our findings support the concept that FeNO should not be used in isolation to predict EIB in athletes, it is important to acknowledge that FeNO has an established role in the assessment of type 2 airway inflammation and should therefore be considered as an adjunct measure to support diagnostic work-up and/or monitor the effectiveness of inhaler therapy. 45,46 Furthermore, the measurement of FeNO is simple and requires less patient effort when compared to measuring maximal spirometry and completing an EVH challenge. From a practical point of view, athletes with EIB are therefore likely to appreciate the inclusion of FeNO as part of long-term management as opposed to repeat indirect bronchial provocation.…”