Field Exercise vs Laboratory Eucapnic Voluntary Hyperventilation To Identify Airway Hyperresponsiveness in Elite Cold Weather Athletes* Kenneth W. Rundell, PhD; Sandra D. Anderson, DSc; Barry A. Spiering, MS; and Daniel A. Judelson, MA Study objective: For the 2002 Winter Olympic Games, athletes were required to submit objective evidence of asthma or exercise-induced bronchoconstriction (EIB) for approval to inhale a  2 -agonist. Eucapnic voluntary hyperventilation (EVH) was recommended as a laboratory challenge that would identify airway hyperresponsiveness (AHR) consistent with EIB. The objective was to compare the change in FEV 1 provoked by EVH with that provoked by exercise in cold weather athletes. Design: Spirometry was measured before and for 15 min after challenges. The two challenges were performed in random order at least 24 h apart. Setting: EVH was performed in the laboratory at 19°C, and exercise took place in the field in the cold (2°C, 45% relative humidity). Participants: Thirty-eight athletes (25 female subjects; median age, 16 years). Interventions: For the EVH, athletes inhaled dry air containing 5% carbon dioxide for 6 min at a target ventilation equivalent to 30 times baseline FEV 1 . Exercise was performed by cross-country skiing, ice skating, or running for 6 to 8 min. Measurements and results: AHR consistent with EIB was defined as > 10% fall in FEV 1 from baseline after challenge. Eleven athletes were exercise positive (EX) [FEV 1 fall, 20.5  7.3%], and 17 athletes were EVH positive (FEV 1 fall, 14.5  4.5%) [mean  SD]. Of 19 subjects with AHR, 58% were identified by exercise and 89% were identified by EVH. EVH identified 9 of 11 subjects who were EX and a further 8 subjects with potential for EIB. The average ventilation during EVH was 28 times FEV 1 . Conclusion: Performing EVH for 6 min in the laboratory had a greater chance of identifying AHR in these athletes compared with 6 to 8 min of field exercise in the cold. The EVH test will be useful to evaluate elite summer sports athletes whose widely different forms of exercise provide an “equipment” challenge to any laboratory. (CHEST 2004; 125:909 –915) Key words: airway hyperresponsiveness; dry air; exercise; exercise-induced bronchoconstriction; eucapnic voluntary hyperpnea Abbreviations: AHR = airway hyperresponsiveness; EIB = exercise-induced bronchoconstriction; EVH = eucapnic voluntary hyperpnea; EVH+= positive to eucapnic voluntary hyperpnea; EVH-= negative to eucapnic voluntary hyperpnea; EX+= positive to exercise; EX-= negative to exercise; FEF 25–75 = forced expiratory flow through the mid-portion of the vital capacity; MVV = maximum voluntary ventilation; NS = not significant L aboratory evaluation of exercise-induced bron- choconstriction (EIB) is increasingly important, as the reported prevalence of the problem has reached epidemic proportions both among elite ath- letes 1 and the general population. 2 Approximately 25% of 1998 US Winter Olympic athletes were identified as EIB positive by spirometry, with as many as 50 to 60% of the athletes in certain sport disciplines afflicted. 3,4 Among 1996 US Summer Olympians, 15.3% reported a previous diagnosis of asthma, exercise-induced asthma, or EIB. 1 While self-reported symptoms (cough, wheeze, chest tightness, excess mucus production) are often used as the sole diagnostic tool, they have been *From Marywood University (Dr. Rundell and Mr. Spiering), Scranton, PA; United States Olympic Committee at Lake Placid (Mr. Judelson), Lake Placid, NY; and Royal Prince Alfred Hospital (Dr. Anderson), Camperdown, NSW, Australia. Manuscript received March 31, 2003; revision accepted Septem- ber 8, 2003. Reproduction of this article is prohibited without written permis- sion from the American College of Chest Physicians (e-mail: permissions@chestnet.org). Correspondence to: Kenneth W. Rundell, PhD, Professor of Health Science, Director of the Human Performance Laboratory, Marywood University, 2300 Adams Ave, Scranton, PA 18509- 4742; e-mail rundell@marywood.edu www.chestjournal.org CHEST / 125 / 3 / MARCH, 2004 909