20%. The test is concluded but considered negative if
the maximum solution concentration of 25 mg/mL is
administered without the diagnostic drop in FEV1
(Eliasson, Phillips, and Rajagopal, 1992).- Albuterol may be given 3 min after a positive test to
demonstrate airway bronchospasm reversibility that is
consistent with asthma.
EUCAPNIC VOLUNTARY HYPERVENTILLATION
(EVH) TEST
- Used by the International Olympic Committee-
Medical Committee (IOC-MC) to verify EIA and the
need for precompetition beta agonist (Anderson et al,
2003). - Sensitivity in athletes has been shown to be 50% sen-
sitive and up to 100% specific (Eliasson, Phillips, and
Rajagopal, 1992). - EVH is a well-known and accepted provocative test
for EIA (Holzer, 2002; Mannix, Manfredi, and Farber,
1999). - This test is more sensitive than an exercise challenge
in the field or in the lab (Holzer, 2002; Mannix,
Manfredi, and Farber, 1999). - EVH is more sensitive than methacholine in response
to dry air hyperpnea (Holzer, 2002).
CONDUCTING THEEVH TEST
- Obtain a baseline PFT. Record the best FEV1.
•Argyros and colleagues (Anderson et al, 2001;
Argyros et al, 1995) protocol based on single-level
ventilation of 85% of the maximum voluntary venti-
lation (MVV) is used. MVV is calculated as 35
times the best recorded pretest FEV1 and is used to
calculate the volume of dry gas ventilated per
minute. - The athlete inhales dry gas consisting of 5% carbon
dioxide, 21% oxygen, and the remainder nitrogen gas.
The volume of ventilated gas is measured by a
metered instrument. The athlete gauges and adjusts
the rate of ventilation based on the volume of dry gas
ventilated. - The athlete breaths at a rate of 85% MVV for 6 min.
- At the completion of the 6 min the FEV1 is measured
twice at 1, 3, 5, 7, and 8 min post challenge. The best
FEV1 value is used.
•A drop in FEV1 of at least 20% is diagnostic for EIA
(Holzer, 2002).
•A bronchodialator may be administered at the conclu-
sion of the study to decrease the patient’s symptoms
and document reversibility of airway hyperresponsive-
ness.
EVALUATING ATHLETES WITH
SUSPECTED EIA- The most appropriate provocative test for identifying
EIA remains controversial (Rundell et al, 2001;
Anderson et al, 2001; Eliasson, 1999). - EVH may be the preferred method of laboratory
provocative testing because of its relative ease and
excellent sensitivity. It is also more sensitive than an
exercise challenge in a lab or field environment
(Holzer, 2002; Mannix, Manfredi, and Farber, 1999).
EVH provocative testing is the preferred diagnostic
study of the IOC-MC. - If EVH testing is unavailable, a sport and climate-spe-
cific exercise challenge is an acceptable alternative. A
methacholine challenge is also an acceptable option.
•Avoid empirically treating for EIA without formal
provocative testing. Classic symptoms alone are unre-
liable and may lead to over- or underusage of the
appropriate medical therapy.
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J Asthma28:31–35, 1991.136 SECTION 2 • EVALUATION OF THE INJURED ATHLETE