Diagnosis of exercise-induced bronchoconstriction: eucapnic voluntary hyperpnoea challenges identify previously undiagnosed elite athletes with exercise-induced bronchoconstriction

Br J Sports Med. 2011 Nov;45(14):1126-31. doi: 10.1136/bjsm.2010.072520. Epub 2010 Jul 20.

Abstract

Background: There is increasing evidence to suggest many elite athletes fail to recognise and report symptoms of exercise-induced bronchoconstriction (EIB), supporting the contention that athletes should be screened routinely for EIB.

Purpose: To screen elite British athletes for EIB using eucapnic voluntary hyperpnoea (EVH).

Methods: 228 elite athletes provided written informed consent and completed an EVH challenge with maximal flow volume loops measured at baseline and 3, 5, 10 and 15 min following EVH. A fall of 10% in forced expiratory volume in 1 s (FEV(1)) from baseline was deemed positive. Two-way analysis of variance was conducted to compare FEV(1) at baseline and maximal change following EVH between EVH-positive and EVH-negative athletes who did and did not report a previous diagnosis of EIB. Significance was assumed if p ≤0.05.

Results: Following the EVH challenge 78 athletes (34%) demonstrated EVH positive. 57 out of the 78 (73%) athletes who demonstrated EVH positive did not have a previous diagnosis of EIB. 30 athletes reported a previous diagnosis of asthma, nine (30%) of whom demonstrated EVH negative. There was no significant difference between the magnitude of the fall in FEV(1) between athletes who reported a previous diagnosis of EIB and demonstrated EVH positive, and those with no previous diagnosis of EIB who demonstrated EVH positive (mean±SD; -21.6 ± 16.1% vs -17.1 ± 9.7%; p=0.07).

Conclusion: The high proportion of previously undiagnosed athletes who demonstrated EVH positive suggests that elite athletes should be screened routinely for EIB using a suitable bronchoprovocation challenge.

MeSH terms

  • Adult
  • Bronchial Diseases / diagnosis*
  • Bronchial Diseases / etiology
  • Bronchial Diseases / physiopathology
  • Bronchoconstriction / physiology*
  • Early Diagnosis
  • Exercise / physiology*
  • Forced Expiratory Volume / physiology
  • Humans
  • Hyperventilation / complications*
  • Hyperventilation / physiopathology
  • Sports / physiology*
  • Vital Capacity / physiology
  • Young Adult