Reproducibility of eucapnic voluntary hyperpnoea for exercise-induced bronchoconstriction diagnosis in asthmatic children and adolescents

Abstract

Background: Respiratory symptoms after exercise are frequently reported by asthmatic patients, and exercise-induced bronchoconstriction (EIB) is a frequent cause, which requires objective testing for diagnosis. Eucapnic voluntary hyperpnea (EVH) is recommended as a surrogate stimulus for this purpose. Its short-term reproducibility is not yet established in children and young adolescents with asthma.

Objective: To evaluate the short-term test-retest agreement and reproducibility of FEV₁ changes after EVH in this population.

Methods: Asthmatic patients aged between 10 and 20 years underwent EVH for EIB diagnosis on two occasions 2-4 days apart at a specialized university clinic. FEV₁ was measured at 5, 15, and 30 min after EVH with a target ventilation rate 21 times the baseline FEV₁ . EIB was diagnosed as a decrease ≥10% in FEV₁ from baseline.

Results: A total of 26 of 62 recruited individuals tested positive for EIB on both visits (positive group) and 17 on one visit only (divergent group), while 19 tested negative on both visits (negative group). The overall agreement was 72.5% (95%CI 61.6%, 83.6%), and Cohen's kappa coefficient was 0.452. Low bias (0.87%) and high intra-class correlation coefficient (0.854, 95%CI 0.758,0.912; p < .001) for FEV₁ response between test days were found, but with wide limits of agreement (±20.72%). There were no differences in pre-challenge FEV₁ or achieved ventilation rate between visits either between groups (p = .097 and p = .461) or within groups (p = .828 and p = .780). There were no safety issues.

Conclusions: More than one EVH test should be performed in children and young adolescents with asthma to exclude EIB and minimize misdiagnosis and mistreatment.

Keywords: adolescents; asthma; eucapnic voluntary hyperpnea; exercise-induced bronchoconstriction; indirect bronchoprovocation testing; reproducibility.