open access

Vol 79, No 6 (2011)
ORIGINAL PAPERS
Published online: 2011-10-25
Submitted: 2013-02-22
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Usefulness of selected tests in the diagnosis of exercise induced bronchoconstriction

Katarzyna Hildebrand, Tadeusz Przybyłowski, Marta Maskey-Warzęchowska, Ryszarda Chazan
Pneumonol Alergol Pol 2011;79(6):397-406.

open access

Vol 79, No 6 (2011)
ORIGINAL PAPERS
Published online: 2011-10-25
Submitted: 2013-02-22

Abstract

Introduction: Indirect airway challenge tests are commonly used in the diagnosis of exercise-induced bronchoconstriction (EIB), defined as a post-exercise decrease in FEV1 ≥ 10%. The aim of this study was to evaluate the diagnostic value of bronchial hyperreactivity tests in the diagnosis of EIB.
Material and methods: Forty two subjects were allocated to 3 groups: A — 19 steroid naive asthma patients; D — 11 noasthma patients reporting symptoms suggestive for EIB (dyspnea, wheeze and cough provoked by exercise) and K — 12 healthy controls. Subjects filled a questionnaire regarding symptoms related to exercise and underwent: inhaled bronchial challenge to methacholine (Mch), adenosine 5’-monophosphate (AMP) and exercise challenge on a treadmill. With a cutoff of ≥ 10% or ≥ 15% decrease in FEV1 post exercise EIB was diagnosed in 47% and 37% of asthma patients, respectively; 27% of subjects in group D and in none of controls, irrespectively of the ΔFEV1 criterion.
Results: The analysis of questionnaire revealed that a single symptom cannot be used to predict EIB. Symptoms occurring after termination of exercise, but not during exercise characterize EIB more precisely. The analysis showed that the most useful measure to diagnose EIB can be a combination of bronchial challenge to AMP and typical symptoms of exercise induced bronchoconstriction (i.e. dyspnea, wheezes and cough provoked by exercise) with a sensitivity of 70%, specifity of 94%, PPV of 78%, NPV of 91% and LR of 11.2.
Conclusions: Symptoms suggestive of EIB do not have acceptable sensitivity and specifity for the diagnosis of exerciseinduced bronchoconstriction. The most useful measure to diagnose EIB is a combination of typical symptoms of EIB with positive challenge to AMP.
Pneumonol. Alergol. Pol. 2011; 79, 6: 397–406

Abstract

Introduction: Indirect airway challenge tests are commonly used in the diagnosis of exercise-induced bronchoconstriction (EIB), defined as a post-exercise decrease in FEV1 ≥ 10%. The aim of this study was to evaluate the diagnostic value of bronchial hyperreactivity tests in the diagnosis of EIB.
Material and methods: Forty two subjects were allocated to 3 groups: A — 19 steroid naive asthma patients; D — 11 noasthma patients reporting symptoms suggestive for EIB (dyspnea, wheeze and cough provoked by exercise) and K — 12 healthy controls. Subjects filled a questionnaire regarding symptoms related to exercise and underwent: inhaled bronchial challenge to methacholine (Mch), adenosine 5’-monophosphate (AMP) and exercise challenge on a treadmill. With a cutoff of ≥ 10% or ≥ 15% decrease in FEV1 post exercise EIB was diagnosed in 47% and 37% of asthma patients, respectively; 27% of subjects in group D and in none of controls, irrespectively of the ΔFEV1 criterion.
Results: The analysis of questionnaire revealed that a single symptom cannot be used to predict EIB. Symptoms occurring after termination of exercise, but not during exercise characterize EIB more precisely. The analysis showed that the most useful measure to diagnose EIB can be a combination of bronchial challenge to AMP and typical symptoms of exercise induced bronchoconstriction (i.e. dyspnea, wheezes and cough provoked by exercise) with a sensitivity of 70%, specifity of 94%, PPV of 78%, NPV of 91% and LR of 11.2.
Conclusions: Symptoms suggestive of EIB do not have acceptable sensitivity and specifity for the diagnosis of exerciseinduced bronchoconstriction. The most useful measure to diagnose EIB is a combination of typical symptoms of EIB with positive challenge to AMP.
Pneumonol. Alergol. Pol. 2011; 79, 6: 397–406
Get Citation

Keywords

asthma; exercise-induced bronchoconstriction; bronchial challenge tests

About this article
Title

Usefulness of selected tests in the diagnosis of exercise induced bronchoconstriction

Journal

Advances in Respiratory Medicine

Issue

Vol 79, No 6 (2011)

Pages

397-406

Published online

2011-10-25

Bibliographic record

Pneumonol Alergol Pol 2011;79(6):397-406.

Keywords

asthma
exercise-induced bronchoconstriction
bronchial challenge tests

Authors

Katarzyna Hildebrand
Tadeusz Przybyłowski
Marta Maskey-Warzęchowska
Ryszarda Chazan

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