Mannix E T, Manfredi F, Farber M O
Division of Pulmonary, Critical Care and Occupational Medicine, Indiana University Department of Medicine, Indianapolis 46202, USA.
Chest. 1999 Mar;115(3):649-53. doi: 10.1378/chest.115.3.649.
Studies documenting the increased incidence of exercise-induced bronchospasm (EIB) in figure skaters have employed a method that incorporates on-ice exercise with rink-side spirometry. The literature suggests that bronchial provocation challenge testing is better than exercise testing for identifying EIB. To test this hypothesis in figure skaters, a unique athletic population that trains and competes in cold air, we compared these two methods in the same individuals.
PATIENTS/METHODS: Two challenge tests were performed on a group of competitive figure skaters (n = 29, 26 female subjects; mean+/-SD age = 12.3+/-3.5 years): (1) rink-side (temperature = 14 degrees C, humidity = 60%) spirometry before and 1, 5, 10, and 15 min after 5 min of intense skating; and (2) eucapnic voluntary hyperventilation (EVH), breathing 5% CO2, 21% O2, balance N2 at a rate of 60% of maximum voluntary ventilation (not to exceed 70 L/min) for 5 min (temperature = 18 degrees C, humidity = 50%), with an identical pretest and posttest spirometry schedule. EIB was defined as at least one of the following: a > or =10% decline in Fev1; a > or = 20% decline in maximum midexpiratory flow rate; or a > or = 25% decline in peak expiratory flow rate.
Sixteen of 29 skaters (55%) developed EIB: 9 were positive by on-ice testing; 12 were positive by EVH testing; 5 were positive on both tests; on-ice testing missed 7 skaters with EIB; EVH testing missed 4 with EIB.
In the group of figure skaters studied, EVH challenge testing was better at identifying EIB than on-ice exercise testing. However, these data suggest that evaluation for EIB in athletes who train and compete in the cold should include exercise testing in cold air along with a challenge test such as EVH to increase the yield of positive responders.
有研究记录花样滑冰运动员运动诱发支气管痉挛（EIB）的发病率增加，这些研究采用了一种将冰上运动与场边肺活量测定相结合的方法。文献表明，支气管激发试验在识别EIB方面比运动试验更好。为了在花样滑冰运动员（这是一个在冷空气环境中训练和比赛的独特运动员群体）中验证这一假设，我们在同一受试者身上比较了这两种方法。
患者/方法：对一组竞技花样滑冰运动员（n = 29，26名女性受试者；平均±标准差年龄 = 12.3±3.5岁）进行了两项激发试验：（1）在温度为14℃、湿度为60%的场边，在剧烈滑冰5分钟前及之后1、5、10和15分钟进行肺活量测定；（2）等碳酸自愿过度通气（EVH），吸入5%二氧化碳、21%氧气、其余为氮气，以最大自主通气量的60%（不超过70升/分钟）的速率呼吸5分钟（温度 = 18℃，湿度 = 50%），并采用相同的测试前和测试后肺活量测定时间表。EIB定义为以下至少一项：第一秒用力呼气容积（Fev1）下降≥10%；最大呼气中期流速下降≥20%；或呼气峰值流速下降≥25%。
29名滑冰运动员中有16名（55%）发生EIB：9名冰上测试呈阳性；12名EVH测试呈阳性；5名两项测试均呈阳性；冰上测试漏诊了7名EIB滑冰运动员；EVH测试漏诊了4名EIB滑冰运动员。
在所研究的花样滑冰运动员群体中，EVH激发试验在识别EIB方面比冰上运动试验更好。然而，这些数据表明，对在寒冷环境中训练和比赛的运动员进行EIB评估时，应包括冷空气运动试验以及如EVH这样的激发试验，以提高阳性反应者的检出率。
