Reproducibility of the bronchoconstrictive response to eucapnic voluntary hyperpnoea

Williams, Neil C.; Johnson, Michael; Hunter, Kirsty; Sharpe, GR

doi:10.1016/j.rmed.2015.08.006

Cited by 13 publications

(26 citation statements)

References 39 publications

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“…Inclusion criteria for the control group were: a baseline FEV 1 >65 % of predicted and a <10 % fall in FEV 1 following initial EVH screening. Participants avoided exercise for 24 h before an EVH test, and the HIB group ceased their medication as previously described ( 21 , 24 ) . On EVH test days, participants abstained from caffeine and alcohol and arrived at the laboratory >2 h post-prandial ( 27 , 28 ) .…”

Section: Methodsmentioning

confidence: 99%

“…It is therefore pertinent to establish if lower doses of n- 3 PUFA are effective in reducing EIB. With respect to the simulation of EIB under laboratory conditions, an EVH challenge causes a highly reproducible HIB (a surrogate for EIB) in adults with asthma ( 21 ) which makes this an attractive challenge test to evaluate the effects of n- 3 PUFA treatments on airway hyperresponsiveness. Thus, the aim of the current study was to compare the effects of a 6·2 g/d n- 3 PUFA dose with a half dose of 3·1 g/d n- 3 PUFA on HIB and markers of airway inflammation in adults with asthma.…”

mentioning

confidence: 99%

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Comparable reductions in hyperpnoea-induced bronchoconstriction and markers of airway inflammation after supplementation with 6·2 and 3·1 g/d of long-chainn-3 PUFA in adults with asthma

et al. 2017

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Although high dose n-3 PUFA supplementation reduces exercise- and hyperpnoea-induced bronchoconstriction (EIB/HIB), there are concurrent issues with cost, compliance and gastrointestinal discomfort. It is thus pertinent to establish the efficacy of lower n-3 PUFA doses. Eight male adults with asthma and HIB and eight controls without asthma were randomly supplemented with two n-3 PUFA doses (6·2 g/d (3·7 g EPA and 2·5 g DHA) and 3·1 g/d (1·8 g EPA and 1·3 g DHA)) and a placebo, each for 21 d followed by 14 d washout. A eucapnic voluntary hyperpnoea (EVH) challenge was performed before and after treatments. Outcome measures remained unchanged in the control group. In the HIB group, the peak fall in forced expiratory volume in 1 s (FEV1) after EVH at day 0 (-1005 (sd 520) ml, -30 (sd 18) %) was unchanged after placebo. The peak fall in FEV1 was similarly reduced from day 0 to day 21 of 6·2 g/d n-3 PUFA (-1000 (sd 460) ml, -29 (sd 17) % v. -690 (sd 460) ml, -20 (sd 15) %) and 3·1 g/d n-3 PUFA (-970 (sd 480) ml, -28 (sd 18) % v. -700 (sd 420) ml, -21 (sd 15) %) (P<0·001). Baseline fraction of exhaled nitric oxide was reduced by 24 % (P=0·020) and 31 % (P=0·018) after 6·2 and 3·1 g/d n-3 PUFA, respectively. Peak increases in 9α, 11β PGF2 after EVH were reduced by 65 % (P=0·009) and 56 % (P=0·041) after 6·2 and 3·1 g/d n-3 PUFA, respectively. In conclusion, 3·1 g/d n-3 PUFA supplementation attenuated HIB and markers of airway inflammation to a similar extent as a higher dose. Lower doses of n-3 PUFA thus represent a potentially beneficial adjunct treatment for adults with asthma and EIB.

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Comparable reductions in hyperpnoea-induced bronchoconstriction and markers of airway inflammation after supplementation with 6·2 and 3·1 g/d of long-chainn-3 PUFA in adults with asthma

et al. 2017

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“…The EVH test appears to have good test–retest reproducibility when a subject develops airway narrowing of at least moderate severity (i.e., >20 %) [ 48 , 49 ]; however, it appears to demonstrate poor repeatability at levels approximating a mild fall in FEV 1 (i.e., 10–15 %). Indeed, in a recent study by Price et al [ 50 ], the poor diagnostic repeatability of EVH indicated that, in a cohort of recreational athletes with a mild reduction in FEV 1 post EVH, clinicians should not depend on a single positive test to support or refute a diagnosis.…”

Section: Interpretation Of the Evh Testmentioning

confidence: 99%

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

et al. 2016

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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.

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“…This was unexpected given that swimmers are high ventilation athletes used to hard maximal ventilation efforts,4 which is in keeping with others who found 82% to 88% of target MVV 22. It could be hypothesized that respiratory muscle fatigue may have influenced the performance during the EVH test; however, the swimmers were tested after 4 months of regular training and had had many workouts and competitions which met the ventilation requirements of the EVH test.…”

Section: Discussionmentioning

confidence: 72%

“…In those that have examined reproducibility of the EVH test for the diagnosis of AHR, the evidence is mixed 10132223. Initial determination of reproducibility of pre- and post-test FEV1, FVC, and FEV1/FVC was deemed appropriate based on no statistical difference between spirometry on 2 EVH tests spaced within a 6-week period in individuals all with AHR;23 however, no reliability estimates were provided.…”

Section: Discussionmentioning

confidence: 99%

Is Performance of a Modified Eucapnic Voluntary Hyperpnea Test in High Ventilation Athletes Reproducible?

Kennedy

Steinback

Skow

et al. 2017

Allergy Asthma Immunol Res

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PurposeExercise-induced bronchoconstriction (EIB) is common in “high ventilation” athletes, and the Eucapnic Voluntary Hyperpnea (EVH) airway provocation test is the standard EIB screen. Although the EVH test is widely used, the in-test performance in high ventilation athletes as well as the reproducibility of that performance has not been determined. Reproducibility of pre- and post-test spirometry and self-reported atopy/cough was also examined.MethodsHigh ventilation athletes (competitive swimmers; n=11, 5 males) completed an atopy/cough questionnaire and EVH testing (operator controlled FiCO2) on 2 consecutive days.ResultsSwimmers achieved 85%±9% and 87%±9% of target FEV1 volume on days 1 and 2, respectively, (P=0.45; ICC 0.57 [0.00-0.86]) resulting in a total ventilation of 687 vs 684 L [P=0.89, ICC 0.89 (0.65-0.97]) equating to 83%±8% and 84%±9% of predicted total volume (ICC 0.54 [0.00-0.85]) between days 1 and 2. FiCO2 required to maintain eucapnic conditions was 2.5%. Pre-test FEV1 was less on day 2 (P=0.04; ICC >0.90). Day 1 to 2 post-test FEV1 was not different, and 4 swimmers were EIB positive (>10% fall in pre-post FEV1) on day 1 (3 on day 2).ConclusionsEVH in-test performance is reproducible however required less FiCO2 than standard protocol and the swimmers under-ventilated by 125 and 139 L/min for days 1 and 2, respectively. How this affects EIB diagnosis remains to be determined; however, our results indicate a post-test FEV1 fall of ≥20% may be recommended as the most consistent diagnostic criterion.

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Reproducibility of the bronchoconstrictive response to eucapnic voluntary hyperpnoea

Abstract: Background: Eucapnic voluntary hyperpnoea (EVH) is considered an effective

Cited by 13 publications

References 39 publications

Comparable reductions in hyperpnoea-induced bronchoconstriction and markers of airway inflammation after supplementation with 6·2 and 3·1 g/d of long-chainn-3 PUFA in adults with asthma

Comparable reductions in hyperpnoea-induced bronchoconstriction and markers of airway inflammation after supplementation with 6·2 and 3·1 g/d of long-chainn-3 PUFA in adults with asthma

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

Is Performance of a Modified Eucapnic Voluntary Hyperpnea Test in High Ventilation Athletes Reproducible?

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