Omar Bennett
Exercise-induced asthma (EIA) is a transient increase in airway resistance during or after physical activity, triggering asthma symptoms such as coughing, wheezing, and shortness of breath. EIA testing involves a combination of breathing, exercise, and cardiology tests to assess if exercise induces asthma symptoms and to understand how the heart and lungs work together during exercise. A positive test result indicates the presence of EIA, confirming that exercise triggers asthma symptoms in the individual. This paragraph will discuss the components and interpretation of EIA testing, providing insight into the diagnosis of exercise-induced asthma.
| Characteristics | Values |
|---|---|
| Test type | Direct pharmacological test, Indirect test, Eucapnic Voluntary Hyperpnea Challenge test (EVH test), Methacholine challenge test |
| Test aim | To determine if exercise induces asthma symptoms |
| Test duration | 10-20 minutes for the exercise part of the test, up to 1.5 hours for the whole test |
| Test procedure | Spirometry test before and after exercise, measurement of heart rate, oxygen levels, inhaled oxygen, exhaled carbon dioxide levels, blood oxygen level, heart rate and rhythm |
| Test risks | Increased coughing, wheezing, tightness in the chest, dizziness, fainting, rare complications like heart attack, collapsed lung, retinal detachment |
| Test results | Positive if the decline in FEV1 is greater than 15-20% from baseline value |
| Test treatment | Relief inhaler, inhaled medication to return to baseline |
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What You'll Learn
Spirometry test
Spirometry is a common pulmonary function test for asthma. It is a diagnostic device that measures the amount of air one can breathe in and out. It is used to check how well the lungs function at rest. A spirometer measures how much air you inhale, how much you exhale, and how quickly you exhale. This is done by having the patient take a large breath and then breathe out very hard and fast through a tube connected to a computer. The patient might have to repeat this breathing test several times to get an accurate measurement.
The patient might be asked to repeat the test after taking an inhaled medicine to open their lungs, such as a bronchodilator. The results of the two measurements are compared to see whether the bronchodilator improved the patient's airflow. This initial lung function test is important for ruling out chronic asthma as the cause of symptoms.
Spirometry is also used in the methacholine challenge test, which is a direct test used to diagnose chronic asthma. Methacholine is a drug that causes a transient narrowing of the airways. It is administered in elevating doses, and spirometry is used to measure the patient's lung function after each dose.
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Exercise challenge test
Exercise-induced asthma (EIA), also known as exercise-induced bronchoconstriction, is a condition where the airways narrow during physical activity, triggering asthma symptoms such as coughing, wheezing, and shortness of breath. To diagnose EIA, healthcare providers may conduct an exercise challenge test, also known as a bronchoprovocation test or asthma challenge testing.
The exercise challenge test involves measuring a patient's breathing before and after engaging in physical activity, such as riding a stationary bike or running on a treadmill. The test aims to increase the patient's breathing rate to a level that triggers their symptoms. If necessary, a real-life exercise challenge, such as climbing stairs, may be performed. Spirometry, a pulmonary function test, is often used to measure lung function before and after the exercise. This test can help determine if the patient's airways narrow during exercise, which is characteristic of EIA.
During the exercise challenge test, patients are connected to several machines to measure heart and lung function. A pulse oximeter is placed on the patient's fingertip to measure blood oxygen levels, and electrodes are placed on the chest to measure heart rate and rhythm using an electrocardiogram (EKG) machine. A mouthpiece is used to measure inhaled oxygen and exhaled carbon dioxide levels, and a nose clip ensures breathing through the mouth.
The exercise challenge test is typically combined with a spirometry test to provide evidence of exercise-induced bronchoconstriction. The spirometry test measures the amount of air inhaled, exhaled, and the rate of exhalation. It may be repeated after the patient takes a bronchodilator, a medication that opens the lungs, to compare airflow measurements. This initial lung function test helps rule out chronic asthma as the cause of symptoms.
In addition to the exercise challenge and spirometry tests, other tests may be performed to aid in the diagnosis of EIA. These include a chest X-ray to rule out infections or other causes of symptoms, and a direct flexible laryngoscopy to assess if vocal cords are contributing to breathing difficulties during exercise.
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Chest X-ray
A chest X-ray is often used to rule out other causes of wheezing and shortness of breath in people suspected of having asthma. It is typically used to check for complications of a severe asthma attack in the hospital or emergency room. It can also be used in children under 5 who are unable to perform pulmonary function tests used in asthma diagnosis.
A chest X-ray can provide valuable insights about the disease and help confirm the diagnosis. It can also differentiate asthma from conditions with similar symptoms, thereby ensuring the correct diagnosis. Chest X-rays may be conducted directly at an outpatient clinic or a hospital. At your appointment, you’ll be asked to change out of your clothes from the waist up and put on a gown. You’ll also need to remove jewellery, watches, and other metallic items that may interfere with the X-ray. An X-ray usually takes a few minutes.
In most people with mild cases of asthma, a chest X-ray won’t find any causes for concern. A doctor will likely recommend a combination of tests to help determine the underlying causes so that you’re prescribed the right treatments. Significant advancements have been made in a number of imaging techniques used for evaluating patients with asthma. CT utilizes specific airway and lung density measurements to identify the severity of disease and pathology, while positron emission tomography (PET) can help identify and target lung inflammation.
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Methacholine challenge test
Asthma is often diagnosed based on non-specific "classic" symptoms, which can make diagnosis difficult. Bronchoprovocation testing, such as the methacholine challenge test, is a valuable tool to assess airway hyperreactivity, aiding in diagnosis and management when done correctly.
The methacholine challenge test is the most common form of bronchoprovocation testing. It involves the inhalation of methacholine, a non-selective muscarinic receptor agonist, which acts directly on airway smooth muscle receptors to induce bronchoconstriction. The dose or concentration is gradually increased in small increments while monitoring airway hyperreactivity via the resultant decreased forced expiratory volume in one second (FEV1). The provocative dose (PD20) or concentration (PC20) resulting in a 20% decrease in FEV1 indicates a positive test.
The methacholine challenge test is useful in evaluating symptoms suggestive of asthma and response to therapy. However, it is important to note that the test has a high incidence of false-positive results in conditions such as allergic rhinitis, chronic obstructive pulmonary disease (COPD), bronchitis, and cystic fibrosis. Factors such as smoking, respiratory infection, exercise, and caffeine consumption on the day of the test can also confound the results.
The methacholine challenge test is generally safe, but it has some contraindications. Patients with low baseline lung function or airflow limitations may be at risk of serious respiratory reactions due to further declines in lung function caused by methacholine-induced bronchospasm. In younger patients, hypoxemia is a concern, but it can be safely managed with pulse oximetry and transcutaneous oxygen pressure. Methacholine is also a pregnancy category C drug, and its effects on fetal development are unknown.
The methacholine challenge test provides valuable information for diagnosing exercise-induced asthma, which occurs when airways narrow during physical activity, triggering asthma symptoms such as coughing, wheezing, or shortness of breath. Exercise challenge tests, also called bronchoprovocation tests, involve riding a stationary bike or running on a treadmill while measuring breathing before and after exercise. This test mimics the conditions that trigger exercise-induced bronchoconstriction, providing valuable insights into the condition.
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Eucapnic voluntary hyperpnea challenge test
Exercise-induced asthma, also known as exercise-induced bronchoconstriction (EIB) or sports-induced asthma, occurs when airways constrict during physical activity, triggering symptoms such as coughing, wheezing, and shortness of breath. This condition is particularly prevalent among athletes, with studies suggesting that between 30% and 70% of elite athletes experience it.
To diagnose EIB, healthcare providers often begin with a medical history, physical exam, and lung function tests. One common lung function test is spirometry, which measures airflow before and after inhaling a bronchodilator. However, spirometry has limitations in diagnosing EIB, leading to the development of alternative tests, including the eucapnic voluntary hyperpnea (EVH) challenge test.
The EVH challenge test is considered the gold standard for diagnosing EIB in athletes. It involves measuring spirometric indices of airflow before and after an exercise bout, but it differs from traditional exercise tests in that it maintains a eucapnic balance by admixing approximately 5% CO2 in the inspirate. This test can be performed in a laboratory setting and modified to replicate the environmental conditions of the patient's specific sport.
During the EVH test, athletes are connected to machines that measure heart rate, heart rhythm, and oxygen levels. A mouthpiece is used to measure inhaled oxygen and exhaled carbon dioxide levels, and a nose clip ensures breathing through the mouth only. The EVH test can help distinguish between mild, moderate, and severe EIB, with a fall in FEV1 (forced expiratory volume in 1 second) of ≥10% considered positive.
The EVH test is valuable for diagnosing EIB in asymptomatic athletes who may not exhibit respiratory symptoms during a physical examination. It helps identify airway hyperresponsiveness that can develop from repeated episodes of exercise hyperpnea in challenging environments. However, caution is advised when interpreting mild post-challenge reductions in lung function, and supplementary tests may be necessary for a comprehensive evaluation.
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Frequently asked questions
An exercise-induced asthma test is a combination of several breathing, exercise, and cardiology tests that show how the heart and lungs work together during exercise.
During the test, the patient will be connected to several machines to take heart and lung measurements before, during, and after exercise. The patient will be asked to perform up to eight minutes of exercise on either a bike or a treadmill at a set pace. The breathing test will then be repeated at set intervals for 20 minutes.
Exercise-induced asthma is diagnosed through a combination of tests, including spirometry, pulmonary function tests, and exercise challenge tests. The patient's medical history and physical exam are also considered.
A positive exercise-induced asthma test indicates that the patient has exercise-induced asthma. This means that their airways do not respond normally to exercise, and they may experience symptoms such as severe shortness of breath, difficulty breathing, coughing, or chest tightness. A methacholine challenge test is considered positive if the decline in FEV1 is greater than 20% from the baseline value. Alternatively, a positive result can also be indicated by a decline in FEV1 greater than 15%.
