In this issue of CHEST, (see page 649) Mannix
and colleagues report their findings from bronchoprovocation testing in
a group of competitive figure skaters. This report raises issues that
deserve further comment.
First, the study illustrates important difficulties with
bronchoprovocation testing. The authors identified 16 of 29 skaters
(55%) who could be provoked by either on-ice exercise or eucapnic
voluntary hyperventilation (EVH).1 Only five of those with
a positive response were provoked by both tests, and one skater with
known asthma failed to be provoked by either test. Furthermore, EVH was
shown to be a more potent stimulus of bronchospasm than on-ice
exercise. This finding raises the question of what to do about those
skaters who respond to EVH but who do not respond with pulmonary
function test (PFT) changes to the stimulus of immediate importance,
their skating routine. It would be improper to label these skaters as
having exercise-induced asthma or to treat these asymptomatic skaters.
How can this disparate information be interpreted?