Eucapnic Voluntary Hyperventilation as a Bronchoprovocation Technique

Development of a Standardized Dosing Schedule in Asthmatics

¹ From the Pulmonary and Critical Care Medicine Service, Department of Medicine, Walter Reed Army Medical Center, Washington, DC; the Uniformed Services University of the Health Sciences, Bethesda, Md
² From the US Army Institute of Environmental Medicine, Natick, Mass

A variety of dosing schedules have been reported for the hyperventilation method of bronchoprovocation testing. To evaluate the effect of challenge technique on the bronchoconstrictive response, we had 16 subjects perform eucapnic voluntary hyperventilation (EVH) with dry, room temperature gas using four different dosing schedules. The hyperventilation challenge dosages included the following: (1) a target minute ventilation (VE) of 20xFEV₁ for 6 min; (2) a target VE of 15xFEV₁for 12 min; (3) an interrupted challenge with a target VE of 30xFEV₁ for 2 min repeated 3 times; and (4) a target VE of 30xFEV₁ for 6 min. Challenges 2, 3, and 4 gave identical absolute ventilatory challenges (identical factor FEV₁xminutes) but at different VE dosages or time. Challenges 1 and 4 were of identical length, but different target VE. The mean postchallenge fall in FEV₁ was 16.6±10.9%, 11.0±8.1%, 19.6±9.9%, and 26.7±11.3% for challenges 1, 2, 3, and 4, respectively. The response to an identical EVH challenge (FEV₁x30 for 6 min) was reproducible when performed on separate days. We conclude that the challenge technique used for hyperventilation testing will have a significant impact on the bronchoconstrictive response and must be taken into account when interpreting study results. Tests may be quantitatively comparable over a narrow range of challenge time and VE. We recommend that a 6-min uninterrupted EVH challenge using dry, room temperature gas at a target VE of 30xFEV₁ be adopted as the "standard"challenge.

Key Words: asthma • bronchoprovocation • exercise • hyperventilation

Submitted on September 5, 1995
Accepted on January 30, 1996

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