Table 1 Diagnosis methods and positivity criteria set by the International Olympic Committee to document exercise-induced bronchoconstriction in athletes [1, 4, 6]
MethodProtocolPositivity criteria
Bronchodilatation testFEV1 before and 15 min after inhalation of a standard β2-agonistFEV1 increase from baseline ≥200 mL and ≥12% of predicted
Bronchial provocation challenges
 Methacholine testProvocative dose (PD20) or concentration (PC20) of inhaled methacholine inducing an FEV1 decrease from baseline ≥20%PC20 ≤4 mg·mL−1 or PD20 ≤400 μg (cumulative dose), or ≤200 μg (noncumulative dose) in those not taking ICS PC20 ≤16 mg·mL−1 or PD20 ≤1,600 μg (cumulative dose) or ≤800 μg (noncumulative dose) in those taking ICS for at least 1 month
 Eucapnic voluntary hyperpnoeaFEV1 before and within 30 min of 6 min dry (or dry and cool) air inhalation at 85% of predicted maximum voluntary ventilation≥10% decrease in FEV1 from baseline
 Hypertonic saline inhalationFEV1 before and after inhaling 22.5 mL of 4.5% NaCl≥15% decrease in FEV1 from baseline
 Mannitol inhalationProvocative dose of inhaled mannitol inducing FEV1 decrease from baseline ≥15% (PD15M)PD15M ≤635 mg of mannitol
 Exercise challenge (field or laboratory)FEV1 before and within 30 min after exercise challenge achieving a heart rate >85% for at least 4 min≥10% decrease in FEV1 from baseline
  • FEV1: forced expiratory volume in 1 s; ICS: inhaled corticosteroids.