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Inconsistent calculation methodology for the eucapnic voluntary hyperpnoea test affects the diagnosis of exercise-induced bronchoconstriction
  1. Sarah Koch1,
  2. Sean Michael Sinden1 and
  3. Michael Stephen Koehle1,2
  1. 1 School of Kinesiology, University of British Columbia, Vancouver, Canada
  2. 2 Faculty of Medicine, University of British Columbia, Vancouver, Canada
  1. Correspondence to Dr Sarah Koch; sarahkoch{at}


Introduction The eucapnic voluntary hyperpnoea (EVH) challenge is used to screen for exercise-induced bronchoconstriction. Several criteria have been proposed to determine the decrease in lung function (fall index, FI) following EVH. We compared three published FI calculation methods to determine if they affect the diagnostic classification.

Methods The three FIs were calculated for 126 EVH tests. Spirometry was performed in duplicate at baseline and repeated 3, 5, 10, 15 and 20 min following 6 min of EVH. The higher of the two forced expiratory volume in 1 s (FEV1) measures at all time-points post-hyperpnoea was selected for the calculation of the FIs. The FIA was determined as the single lowest of the five postchallenge values, and a test was considered positive if FEV1 decreased ≥10 %. In FIB, a test was considered positive if FEV1 decreased ≥10% at two consecutive post-challenge time-points. The FIC was calculated identically to FIA, but was normalised to the achieved minute ventilation during the EVH challenge.

Results Calculation method affected the raw FIs with FIB generating the smallest and FIC generating the highest values (p<0.001) and a within-subject range of 7%±10%. The number of positive tests differed between the calculation criteria: FIA: 62, FIB: 48 and FIC: 70, p<0.001. Nineteen participants (15%) tested positive in one or two FI methods only, indicating that the FI method used determined whether the test was positive or negative.

Discussion Inconsistency in methodology of calculating the FI leads to differences in the diagnostic rate of the EVH test, with potential implications in both treatment and research outcomes.

  • asthma
  • asthma guidelines
  • exercise
  • lung physiology
  • asthma in primary care
  • respiratory measurement

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  • Contributors SMS and SK collected and analysed the data. MSK secured funding and provided guidance throughout the analyses. All three coauthors (SMS, MSK and SK) wrote and reviewed the manuscript together.

  • Funding Funding for this project was kindly provided by the World Anti-Doping Agency (WADA) and the Natural Sciences and Engineering Research Council of Canada (NSERC).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval University of British Columbia, Vancouver, Canada. Clinical Research Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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