Chest

Chest

Volume 115, Issue 3, March 1999, Pages 649-653
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Clinical Investigations
Asthma
A Comparison of Two Challenge Tests for Identifying Exercise-Induced Bronchospasm in Figure Skaters

https://doi.org/10.1378/chest.115.3.649Get rights and content

Objectives

Studies documenting the increased incidence of exercise-induced bronchospasm (EIB) in figure skaters have employed a method that incorporates on-ice exercise with rink-side spirometry. The literature suggests that bronchial provocation challenge testing is better than exercise testing for identifying EIB. To test this hypothesis in figure skaters, a unique athletic population that trains and competes in cold air, we compared these two methods in the same individuals.

Patients/methods

Two challenge tests were performed on a group of competitive figure skaters (n = 29, 26 female subjects; mean ± SD age = 12.3 ± 3.5 years): (1) rink-side (temperature = 14°C, humidity = 60%) spirometry before and 1, 5, 10, and 15 min after 5 min of intense skating; and (2) eucapnic voluntary hyperventilation (EVH), breathing 5% CO2, 21% O2, balance N2 at a rate of 60% of maximum voluntary ventilation (not to exceed 70 L/min) for 5 min (temperature = 18°C, humidity = 50%), with an identical pretest and posttest spirometry schedule. EIB was defined as at least one of the following: a ≥1 0% decline in Fev1; a≥ 20% decline in maximum midexpiratory flow rate; or a ≥ 25% decline in peak expiratory flow rate.

Results

Sixteen of 29 skaters (55%) developed EIB: 9 were positive by on-ice testing; 12 were positive by EVH testing; 5 were positive on both tests; on-ice testing missed 7 skaters with EIB; EVH testing missed 4 with EIB.

Conclusion

In the group of figure skaters studied, EVH challenge testing was better at identifying EIB than on-ice exercise testing. However, these data suggest that evaluation for EIB in athletes who train and compete in the cold should include exercise testing in cold air along with a challenge test such as EVH to increase the yield of positive responders.

Section snippets

Subjects

Twenty-nine figure skaters (26 female) who were participants in a figure skating training camp and who ranged in age from 8 to 25 years (mean ± SD age = 12.3 ± 3.5 years) volunteered for this study that was conducted at the Indiana/World Skating Academy in Indianapolis, IN. Written informed consent was obtained from all subjects prior to testing. The competition level of the skaters ranged from prejuvenile to senior and included one coach. Three of the skaters had been diagnosed previously with

Results

When results from both challenge testing procedures were considered, a total of 16 of 29 skaters (55%) experienced EIB: 9 of 29 skaters (31%) were positive by on-ice testing; 12 of 29 (41%) were positive by EVH testing; 5 individuals were positive for EIB on both tests. Of primary import, on-ice testing missed seven skaters with EIB and the EVH test missed four skaters with EIB. Of the three skaters previously diagnosed as having asthma, two tested positive for EIB and the third failed to meet

Discussion

The most important finding of this investigation is that, in the group of competitive figure skaters studied, the EVH test was better able to identify the presence of EIB than rink-side spirometry performed before and after vigorous skating. Of further note, EVH testing was not perfect, as it failed to identify four skaters who responded positively for EIB by the on-ice exercise test.

The reason why each test failed to uncover all of those with EIB is unclear. The fact that these athletes have

References (15)

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    In part, this may be explained by the inadequacy of the exercise task, variable inspired air conditions, or the lack of attention to the conditions preceding the test, particularly recent exercise or the withholding of medication (see Table 2; Table 3). Elite athletes are a special case in that sport-specific exercise in the field, under the appropriate conditions, may be required in the event of negative results of exercise tests or surrogates for exercise in the laboratory.2,6,10 The thermal and vascular effects are expected to be the greatest under conditions of inspiring air of subfreezing temperatures (such as in winter sports), less important when breathing warm humid air (such as during swimming),36,37 and absent under conditions of breathing hot dry air.38,39

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Copyright © 1999 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.