Eucapnic Voluntary Hyperventilation Is Superior to Methacholine Challenge Testing for Detecting Airway Hyperreactivity in Nonathletes

Abstract

Introduction. Response to eucapnic voluntary hyperventilation (EVH) has not been compared with methacholine challenge testing (MCCT) in nonathletes being evaluated for dyspnea on exertion. Objective. To determine the airway response to EVH and MCCT in a population of nonathletes who exercise regularly but have symptoms with exertion. Methods. We reviewed records for all patients with exercise symptoms who underwent both EVH and MCCT. Presenting symptoms, comorbid diseases, and results of bronchoprovocation (BP) testing were recorded. This study was approved by the institutional review board at our hospital. Results. A total of 131 patients (mean age 32.3 ± 11.6, body mass index (BMI) 27.1 ± 4.7 kg/m², 59.5% male) had an EVH, MCCT, and clinical evaluation performed. Overall, 37 (28.2%) patients had positive BP testing and met criteria for exercise-induced bronchoconstriction (EIB). There were 32 (24.4%) patients with a positive EVH, compared with only 11 patients with a positive MCCT (8.4%). There were 26 patients (19.8%) who had a positive EVH but a negative MCCT, and correlation between the two tests was poor to moderate (r = 0.11–0.57). A complaint of chest pain and younger age were independent predictors for a positive EVH, whereas a history of tobacco use and a decreased FEV₁/FVC (forced expiratory volume in 1 s/forced vital capacity) predicted a positive MCCT. A previous diagnosis of asthma was an independent predictor for a response to either test. Discussion. In a population of nonathletes who exercise regularly and have symptoms with exertion, EIB is common. Correlation between EVH and MCCT in this population is poor, and although the tests are somewhat complementary, a large percentage of patients had a negative MCCT but a positive EVH. Conclusions. EIB is common in nonathletes with exercise-induced symptoms, and EVH is the preferred test for this population. Clinical implications. EIB is common in nonathletes who exercise regularly. In this population, MCCT will miss most patients with EIB, and MCCT and EVH show only poor-to-moderate correlation. Capsule summary: EVH has not been compared with MCCT in nonathletes without a diagnosis of asthma. Our study shows that the two tests are complementary in this population, but EVH is positive more often.

• asthma
• bronchoprovocation testing
• dyspnea
• eucapnic voluntary hyperventilation
• exercise-induced bronchoconstriction
• methacholine challenge

Acknowledgments

Author’s contribution

Brian Cohee: Performed retrospective data gathering, conducted background research, and wrote the introduction, methods, and discussion sections. He also participated in editing the full article and attested for the accuracy and completeness of the data.

Rob Walter: Performed retrospective data gathering, preparation of graphs and figures, and editing of the article.

Anita Shah: Reviewed interpretations of ultimate diagnosis and edited the article.

Chris King: Participated in study design and edited the article.

Stuart Roop: Developed the initial study concept and edited the article.

Aaron Holley: Developed the initial study concept and study design, performed statistical analysis, wrote the abstract and results section, reviewed interpretations of the ultimate diagnosis, and edited the full article and attested for the accuracy and completeness of the data.

Funding Source: This research was not separately funded.

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.