Internal Medicine, Providence Portland Medical Center, Portland, OR, USA.
The Oregon Clinic, Pulmonary and Critical Care, Portland, OR, USA.
J Asthma. 2022 Jan;59(1):145-151. doi: 10.1080/02770903.2020.1827423. Epub 2020 Oct 1.
Exercise-induced bronchoconstriction (EIB) is a common condition and is typically treated empirically based on symptoms alone. However, symptoms of EIB are typically nonspecific. Objective testing with eucapnic voluntary hyperpnea (EVH) is a sensitive and specific method to diagnose EIB and may suggest alternative etiologies such as exercise-induced laryngeal obstruction (EILO). To this point, EVH has been primarily utilized in large academic centers and in elite athletes. We intend to discuss the feasibility and clinical application of utilizing EVH to diagnose EIB in a community-based pulmonary practice. Retrospective analysis of 62 patients who completed EVH at The Oregon Clinic Pulmonary Clinic. Patients with inspiratory flow volume loop flattening or clinical symptoms were assessed by otolaryngology for evidence of EILO.: 61 of 62 patients were included in the final analysis. 52 of 61 patients (85%) achieved an interpretable test with a maximum voluntary ventilation (MVV) >60%. There was no difference in baseline spirometry or patient characteristics between those who were able to reach an MVV >60% and those who did not. 14 (23%) patients were diagnosed with EIB, 18 (30%) with EILO, and 4 (7%) were diagnosed with both EIB and EILO. Only 1 patient had a non-diagnostic evaluation with MVV <60% and negative for EIB and EILO.EVH is a feasible diagnostic modality to evaluate for EIB in a community pulmonary practice and may suggest alternative conditions such as EILO. Accurate diagnosis is paramount to prescribing proper therapy, decreasing inappropriate medication use, and relieving exercise-induced symptoms.
运动诱发性支气管收缩（EIB）是一种常见病症，通常仅根据症状进行经验性治疗。然而，EIB 的症状通常是非特异性的。使用呼碱性自主过度通气（EVH）进行客观测试是诊断 EIB 的一种敏感且特异的方法，并且可能提示其他病因，如运动诱发的喉阻塞（EILO）。到目前为止，EVH 主要在大型学术中心和精英运动员中使用。我们旨在讨论在基于社区的肺科实践中使用 EVH 诊断 EIB 的可行性和临床应用。对在俄勒冈诊所肺科诊所进行 EVH 的 62 例患者进行回顾性分析。对吸气流量容积环变平或有临床症状的患者进行耳鼻喉科评估，以发现 EILO 的证据。：最终分析包括 62 例患者中的 61 例。61 例患者中的 52 例（85％）的最大自主通气量（MVV）> 60％，获得了可解释的测试。能够达到 MVV> 60％的患者与不能达到 MVV> 60％的患者之间的基线肺活量测定和患者特征无差异。14 例（23％）患者被诊断为 EIB，18 例（30％）为 EILO，4 例（7％）同时患有 EIB 和 EILO。只有 1 例患者 MVV<60％的非诊断评估，EIB 和 EILO 均为阴性。EVH 是在社区肺科实践中评估 EIB 的可行诊断方法，并且可能提示其他疾病，如 EILO。准确的诊断对于正确的治疗至关重要，可以减少不适当的药物使用，并缓解运动引起的症状。
