Brummel Nathan E, Mastronarde John G, Rittinger David, Philips Gary, Parsons Jonathan P
Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, The Ohio State University Medical Center, Columbus, Ohio, USA.
J Asthma. 2009 Sep;46(7):683-6. doi: 10.1080/02770900902972178.
Exercise-induced bronchospasm (EIB) is the acute, transient airway narrowing associated with exercise. Eucapnic voluntary hyperventilation (EVH) has been used to diagnose EIB in elite athletes and in research settings. The clinical utility of EVH in a general pulmonary practice has not previously been reported. Thus we sought to determine the utility and applicability of EVH testing in the clinical setting.
We retrospectively analyzed 178 EVH tests performed at the Ohio State University Medical Center.
A total of 178 EVH studies were performed. Fifty patients (28%) were EIB-positive. A threshold of 60% of the predicted maximum voluntary ventilation (MVV) per minute was used as a criterion for an adequate EVH test. A majority of patients, 127 (71%), had adequate EVH tests. Females were less likely to achieve 60% MVV than males (80% vs. 55%; p = 0.002). Of the 51 patients with inadequate tests, 17 (33%) were EIB-positive; 16 of these 17 were female. Overall, EVH testing was diagnostic in 144 of 178 (81%) of patients tested.
We present the first description of the clinical use of EVH testing for the diagnosis of EIB in a large pulmonary practice. EVH was diagnostic in a large majority of patients. EVH is an excellent and feasible modality to diagnose EIB in patients seen in a general pulmonary practice. Our data highlight the need for further studies regarding the appropriate minimum threshold minute ventilation for an EVH test and to explain potential mechanisms for seemingly different stimulus thresholds for bronchospasm in males versus females.
运动诱发的支气管痉挛（EIB）是与运动相关的急性、短暂性气道狭窄。等二氧化碳通气过度（EVH）已被用于精英运动员和研究环境中EIB的诊断。此前尚未报道EVH在普通肺科临床实践中的应用价值。因此，我们试图确定EVH检测在临床环境中的实用性和适用性。
我们回顾性分析了在俄亥俄州立大学医学中心进行的178次EVH检测。
共进行了178项EVH研究。50例患者（28%）EIB呈阳性。将每分钟预计最大自主通气量（MVV）的60%作为EVH检测充分的标准。大多数患者，即127例（71%），进行了充分的EVH检测。女性达到60% MVV的可能性低于男性（80%对55%；p = 0.002）。在51例检测不充分的患者中，17例（33%）EIB呈阳性；这17例中的16例为女性。总体而言，178例接受检测的患者中有144例（81%）通过EVH检测得到诊断。
我们首次描述了EVH检测在大型肺科临床实践中用于诊断EIB的临床应用情况。大多数患者通过EVH检测得到诊断。EVH是在普通肺科临床中诊断EIB的一种优秀且可行的方法。我们的数据凸显了有必要进一步研究EVH检测合适的最低分钟通气阈值，并解释男性和女性支气管痉挛刺激阈值看似不同的潜在机制。
