Abstract: Poster Presentations |


Brian Cohee, MD*; Rob Walter, MD; Anita Shah, DO; Christopher S. King, MD; Stuart Roop, MD; Aaron B. Holley
Author and Funding Information

Walter Reed Army Medical Center, Washington, DC


Chest. 2009;136(4_MeetingAbstracts):3S. doi:10.1378/chest.136.4_MeetingAbstracts.3S-a
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PURPOSE:  Methacholine challenge testing (MCCT) and eucapneic voluntary hyperventilation (EVH) are two forms of bronchoprovocation testing used to diagnose asthma. EVH is reported to have a higher sensitivity for detecting exercise induced symptoms, while MCCT is very sensitive for detecting allergic and occupational disease. We wanted to compare performance characteristics for both tests in a military population presenting with asthma symptoms.

METHODS:  We identified individual patients who had both EVH and MCCT performed within the past 3 years. Demographic data, presenting complaints, spirometry, clinical diagnosis, and bronchoprovocation results were abstracted. Asthma diagnosed clinically by the ordering physician, along with a documented response to asthma specific treatment, was used as the gold standard.

RESULTS:  42 patients were identified, with a mean age, BMI, and FEV1/FVC ratio of 34.5±12.2, 26.8±4.4, and 78.0±6.2 respectively. Overall prevalence of asthma, based on clinical diagnosis by the treating physician, was 25%. The most common presenting complaints were dyspnea (65.1%), exercise symptoms (62.8%), and cough (60.5%). Eight patients had a positive EVH, while only one patient had a positive MCCT. The average percent decrease on MCCT when EVH was positive was 8.9%±8.1% versus 7.2%±6.2% when EVH was negative (p = 0.52). Asthma was significantly more likely clinically when EVH was positive (p = 0.02), but not when MCCT was positive. Sensitivity, specificity, and positive and negative predictive values for EVH were 60.0%, 96.4%, 85.7%, and 87.1% respectively. Clinically confirmed asthma with exercise associated symptoms was also significantly more likely when EVH was positive (p = 0.004).

CONCLUSION:  EVH and MCCT have different diagnostic performance characteristics in a group of patients with symptoms consistent with asthma. EVH was more accurate overall and in patients who complain of exercise related symptoms.

CLINICAL IMPLICATIONS:  Patients suspected of having asthma who do not have a significant response to methacholine may require EVH to definitively rule out the diagnosis.

DISCLOSURE:  Brian Cohee, No Financial Disclosure Information; No Product/Research Disclosure Information

Tuesday, November 3, 2009

12:45 PM - 2:00 PM




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