Interpretation of Eucapnic Voluntary Hyperventilation in the Diagnosis of Asthma

¹ From the Pulmonary and Critical Care Medicine Service, Department of Medicine, Walter Reed Army Medical Center, Washington, DC, and the Uniformed Services University of the Health Sciences, Bethesda, Md.

Eucapnic voluntary hyperventilation (EVH) of dry gas is a physiologic bronchoprovocation challenge useful in the diagnosis of asthma. To determine the best parameter and threshold for diagnosis and the proper timing of postchallenge measurements, we reviewed 120 challenges, comparing the decrement from baseline in FVC, FEV₁, mean forced expiratory flow during the middle half of the FVC (FEF_25-75%), and peak expiratory flow rate (PEFR) each at 0, 5, 10, and 20 min postchallenge. After adjustment to a standard minute ventilation of 30 times the baseline FEV₁ for 6 min, the mean response by 90 mild asthmatics differed from 30 normal subjects in all four parameters (p<0.0001). In asthmatics, maximum decline from baseline (mean±SEM) was as follows: FVC, 12.1±1.2%; FEV₁, 19.7±1.7%; FEF_25-75%, 33.5±2.5%; and PEFR, 29.0±1.9%. Normal subjects had a maximum fall as follows: FVC, 2.9±0.7%; FEV₁, 3.8±0.7%; FEF_25-75%, 11.8±2.0%; and PEFR, 11.5±1.0%. Based on comparison of receiver operator characteristic curves, FEV₁ was more accurate than FEF_25-75% and equivalent to FVC and PEFR. A threshold of 10% change or greater in FEV₁ had a specificity of 90%, with a sensitivity of 63.3%. A threshold of 15% or greater had a specificity of 100%, with a sensitivity of 53.3%. The FEV₁ fell by 10% or more in 55 of 90 asthmatics at 5 or 10 min after hyperventilation. Measurements at 0 or 20 min added two additional positive responses. We conclude that in the proper clinical setting, subjects whose FEV₁ declines by 10% or more at 5 or 10 min after EVH should be diagnosed as having asthma.

Key Words: asthma • bronchoprovocation • exercise-induced asthma • hyperventilation

Submitted on November 28, 1994
Accepted on June 9, 1995

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