Eucapnic Voluntary Hyperpnea: Gold Standard for Diagnosing Exercise-Induced Bronchoconstriction in Athletes?


In athletes, a secure diagnos is of exercise-induced bronchoconstriction (EIB) is dependent on objective testing. Evaluating spirometric indices of airflow before and following an exercise bout is intuitively the optimal means for the diagnosis; however, this approach is recognized as having several key limitations. Accordingly, alternative indirect bronchoprovocation tests have been recommended as surrogate means for obtaining a diagnosis of EIB. Of these tests, it is often argued that the eucapnic voluntary hyperpnea (EVH) challenge represents the ‘gold standard’. This article provides a state-of-the-art review of EVH, including an overview of the test methodology and its interpretation. We also address the performance of EVH against the other functional and clinical approaches commonly adopted for the diagnosis of EIB. The published evidence supports a key role for EVH in the diagnostic algorithm for EIB testing in athletes. However, its wide sensitivity and specificity and poor repeatability preclude EVH from being termed a ‘gold standard’ test for EIB.

Key Points

Despite the long history and widespread use of the eucapnic voluntary hyperpnea (EVH) test in clinical practice, data to support its position as the ‘gold standard’ in the diagnosis of exercise-induced bronchoconstriction (EIB) in athletes are scarce.

The EVH test demonstrates poor test–retest reliability in athletes with mild EIB, and the implications for performance or health in an athlete with a 10–15 % fall in forced expiratory volume in 1 s following EVH still require elucidation.

The EVH test has a key role in diagnosing EIB in athletes but should not be termed the ‘gold standard’. 


Autor / Fonte:James H. Hull, Les Ansley, Oliver J. Price, John W. Dickinson, Matteo Bonini Open AccessArticle First Online: 23 March 2016 DOI: 10.1007/s40279-016-0491-3