Chest
Volume 109, Issue 6, June 1996, Pages 1520-1524
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Clinical Investigations: Airways
Eucapnic Voluntary Hyperventilation as a Bronchoprovocation Technique: Development of a Standardized Dosing Schedule in Asthmatics

https://doi.org/10.1378/chest.109.6.1520Get rights and content

A variety of dosing schedules have been reported for the hyperventilation method of bronchoprovocation testing. To evaluate the effect of challenge technique on the bronchoconstrictive response, we had 16 subjects perform eucapnic voluntary hyperventilation (EVH) with dry, room temperature gas using four different dosing schedules. The hyperventilation challenge dosages included the following: (1) a target minute ventilation ( V˙E) of 20×FEV1 for 6 min; (2) a target V˙E of 15×FEV1 for 12 min; (3) an interrupted challenge with a target V˙E of 30×FEV1 for 2 min repeated 3 times; and (4) a target V˙E of 30×FEVi for 6 min. Challenges 2, 3, and 4 gave identical absolute ventilatory challenges (identical factor FEV1×minutes) but at different V˙E dosages or time. Challenges 1 and 4 were of identical length, but different target V˙E. The mean postchallenge fall in FEV1 was 16.6±10.9%, 11.0±8.1%, 19.6±9.9%, and 26.7±11.3% for challenges 1, 2, 3, and 4, respectively. The response to an identical EVH challenge (FEV1×30 for 6 min) was reproducible when performed on separate days. We conclude that the challenge technique used for hyperventilation testing will have a significant impact on the bronchoconstrictive response and must be taken into account when interpreting study results. Tests may be quantitatively comparable over a narrow range of challenge time and V˙E. We recommend that a 6-min uninterrupted EVH challenge using dry, room temperature gas at a target V˙E of 30×FEV1 be adopted as the “standard” challenge.

Section snippets

MATERIALS AND METHODS

The study was performed in the Pulmonary Clinic of Walter Reed Army Medical Center. Informed consent was obtained from all participants. The study protocol was approved by the hospital's institutional review board for human studies. Sixteen volunteers who met the definition of asthma as proposed by the American Thoracic Society17 in 1962 were recruited. Subjects must have had symptoms (or required treatment) for at least 6 months in an attempt to exclude people with transient reactive airways

RESULTS

The mean age (±SD) of our patients was 33±10 years and there were 12 men and 4 women. Their mean total eosinophil count was 347±607/mm3 (laboratory normal range, 40 to 350/mm3) and mean IgE, 106± 123 IU/mL (laboratory normal range, 3.7 to 269 IU/mL). Fifteen of the 16 subjects had a history of exercise-induced bronchospasm. Ten subjects were regularly using varying doses of both inhaled corticosteroids and β-agonist. One subject was receiving inhaled cromolyn, one subject was taking inhaled

DISCUSSION

When interpreting a bronchoprovocation challenge, one must compare the intensity of the stimulus applied to the intensity of the bronchoconstriction which results. In this study, we have shown that altering the method of EVH challenge technique affects the degree of bronchoconstriction that results, even when the absolute magnitude of the challenge is unchanged. We have also shown that the airway response to identical EVH challenge is reproducible within a 6-week period.

The mechanism of the

ACKNOWLEDGMENT

The authors thank Robin Howard for her assistance with statistical analysis.

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    This work was supported by WRAMC protocol 1755.

    The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Army, Uniformed Services University of the Health Sciences or the Department of Defense.

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