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Eucapnic Voluntary Hyperventilation as a Bronchoprovocation Technique : Development of a Standardized Dosing Schedule in Asthmatics FREE TO VIEW

Gregory J. Argyros; James M. Roach; Kenneth M. Hurwitz; Arn H. Eliasson; Yancy Y. Phillips
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Affiliations: 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,  From the US Army Institute of Environmental Medicine, Natick, Mass

Affiliations: 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,  From the US Army Institute of Environmental Medicine, Natick, Mass


1996 BY THE AMERICAN COLLEGE OF CHEST PHYSICIANS


Chest. 1996;109(6):1520-1524. doi:10.1378/chest.109.6.1520
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Abstract

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.


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