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      Cut‐off values to evaluate exercise‐induced asthma in eucapnic voluntary hyperventilation test for children

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          Abstract

          Background and Aim

          The eucapnic voluntary hyperventilation (EVH) testing is a diagnostic tool for diagnostics of exercise‐induced bronchoconstriction; while the testing has become more common among children, data on the test's feasibility among children remain limited. Our aim was to investigate EVH testing feasibility among children, diagnostic testing cut‐off values, and which factors affect testing outcomes.

          Methods

          We recruited 134 patients aged 10–16 years with a history of exercise‐induced dyspnoea and 100 healthy control children to undergo 6‐min EVH testing. Testing feasibility was assessed by the children's ability to achieve ≥70% of the target minute ventilation of 30 times forced expiratory volume in 1 s (FEV1). Bronchoconstriction was assessed as a minimum of 8%, 10%, 12%, 15% or 20% fall in FEV1. Patient characteristics were correlated with EVH outcomes.

          Results

          Overall, 98% of the children reached ≥70%, 88% reached ≥80%, 79% reached ≥90% and 62% reached ≥100% of target ventilation in EVH testing; of children with a history of exercise‐induced dyspnoea, the decline percentages were as follows: 24% (≥8% fall), 17% (≥10% fall), 10% (≥12% fall), 6% (≥15% fall) and 5% (≥20% fall) in FEV1, compared to 11%, 4%, 3%, 1% and 0% among the healthy controls, respectively. Healthy controls and boys performed testing at higher ventilation rates ( p < .05).

          Conclusion

          Eucapnic voluntary hyperventilation testing is feasible among children aged 10–16 years and has diagnostic value in evaluating exercise‐induced dyspnoea among children. A minimum 10% fall in FEV1 is a good diagnostic cut‐off value. Disease status appears to be important covariates.

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          Most cited references23

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          An official American Thoracic Society clinical practice guideline: exercise-induced bronchoconstriction.

          Exercise-induced bronchoconstriction (EIB) describes acute airway narrowing that occurs as a result of exercise. EIB occurs in a substantial proportion of patients with asthma, but may also occur in individuals without known asthma. To provide clinicians with practical guidance, a multidisciplinary panel of stakeholders was convened to review the pathogenesis of EIB and to develop evidence-based guidelines for the diagnosis and treatment of EIB. The evidence was appraised and recommendations were formulated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Recommendations for the treatment of EIB were developed. The quality of evidence supporting the recommendations was variable, ranging from low to high. A strong recommendation was made for using a short-acting β(2)-agonist before exercise in all patients with EIB. For patients who continue to have symptoms of EIB despite the administration of a short-acting β(2)-agonist before exercise, strong recommendations were made for a daily inhaled corticosteroid, a daily leukotriene receptor antagonist, or a mast cell stabilizing agent before exercise. The recommendations in this Guideline reflect the currently available evidence. New clinical research data will necessitate a revision and update in the future.
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            Provocation by eucapnic voluntary hyperpnoea to identify exercise induced bronchoconstriction.

            The International Olympic Committee Medical Commission (IOC-MC) requires notification for use of a beta(2) agonist at the Winter Olympic Games in Salt Lake City. This notification will be required seven days before the event and must be accompanied by objective evidence that justifies the need to use one. The IOC-MC has expressed the viewpoint that, at present, eucapnic voluntary hyperpnoea (EVH) is the optimal laboratory challenge to confirm that an athlete has exercise induced bronchoconstriction (EIB). The EVH test recommended was specifically designed to identify EIB. EVH has been performed in thousands of subjects in both the laboratory and the field. The test requires the subject to hyperventilate dry air containing 5% carbon dioxide at room temperature for six minutes at a target ventilation of 30 times the subject's forced expiratory volume in one second (FEV(1)). The test conditions can be modified to simulate the conditions that give the athlete their symptoms with exercise. A reduction in FEV(1) of 10% or more of the value before the test is considered positive.
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              Spirometry: step by step

              V.C. Moore (2012)
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                Author and article information

                Contributors
                janne.burman@hus.fi
                Journal
                Clin Physiol Funct Imaging
                Clin Physiol Funct Imaging
                10.1111/(ISSN)1475-097X
                CPF
                Clinical Physiology and Functional Imaging
                John Wiley and Sons Inc. (Hoboken )
                1475-0961
                1475-097X
                26 June 2020
                September 2020
                : 40
                : 5 ( doiID: 10.1111/cpf.v40.5 )
                : 343-350
                Affiliations
                [ 1 ] Skin and Allergy Hospital Helsinki University Hospital and University of Helsinki Helsinki Finland
                [ 2 ] Department of Pediatrics and Adolescent Medicine Turku University Hospital and University of Turku Turku Finland
                [ 3 ] Department of Physics and Astronomy University of Turku Turku Finland
                [ 4 ] Department of Pediatrics Kuopio University Hospital Kuopio Finland
                Author notes
                [*] [* ] Correspondence

                Janne Burman, Skin and Allergy Hospital, Helsinki University Hospital, PO Box 160, FIN 00029 HUS, Finland.

                Email: janne.burman@ 123456hus.fi

                Author information
                https://orcid.org/0000-0002-1177-455X
                https://orcid.org/0000-0001-9264-9904
                https://orcid.org/0000-0002-2933-3111
                https://orcid.org/0000-0002-3204-5639
                https://orcid.org/0000-0003-2748-5362
                Article
                CPF12647
                10.1111/cpf.12647
                7496314
                32491255
                fcae888e-18d2-4a35-aa64-4d6a497fb9ac
                © 2020 The Authors. Clinical Physiology and Functional Imaging published by John Wiley & Sons Ltd on behalf of Scandinavian Society of Clinical Physiology and Nuclear Medicine

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 19 December 2019
                : 25 March 2020
                : 25 May 2020
                Page count
                Figures: 3, Tables: 3, Pages: 8, Words: 5531
                Funding
                Funded by: Jalmari and Rauha Ahokas Foundation , open-funder-registry 10.13039/100010125;
                Funded by: Asthma and Allergy Foundation of Helsinki
                Funded by: Sigrid Juselius Foundation
                Funded by: Kerttu and Kalle Viik Foundation
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                September 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.0 mode:remove_FC converted:11.09.2020

                Anatomy & Physiology
                asthma,bronchoconstriction,children,eucapnic voluntary hyperventilation test,exercise‐induced dyspnoea,feasibility,pulmonary function

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