Identification of the Predictors of a Positive Eucapnic Voluntary Hyperpnea Test in Subjects Investigated for Asthma or Exercise-induced Bronchoconstriction
Bibliographic record
Abstract
Abstract Rationale Eucapnic voluntary hyperpnea (EVH) is the gold standard for identifying exercise-induced bronchoconstriction (EIB) in athletes, as supported by the International Olympic Committee (IOC). The relationship between the mean minute-ventilation (meanVe%MVV) during EVH and test positivity, alongside other clinical characteristics, remains unclear. This study aims to identify clinical and physiological markers predictive of a positive EVH test in a real-life setting. Methods We conducted a retrospective analysis of subjects who underwent EVH testing at our center from 2015 to 2024. We assessed anthropometric and demographic data, pulmonary function test results, pretest physician-assessed probability of asthma/EIB, EVH test characteristics (including meanVe%MVV), and serum levels of eosinophils and IgE as potential predictors of a positive EVH test. Results We analyzed 202 subjects, consisting of 77 males (38%), with a mean age of 35±16 years and FEV1 of 100±13% predicted, including 95 athletes (47%). Only 9 subjects (5%) had a meanVe%MVV value of < 60%. In the whole study sample, 65 subjects (32%) had a positive EVH test (EVH+ group). meanVe%MVV was 71±10% and did not significantly differ between the EVH+ and EVH-groups (70±8 vs 71±10 % of MVV, p=0.22). The area under the ROC curve for meanVe%MVV to identify a positive EVH test was 0.52 [95%CI 0.44-0.60, p=0.63). The maximal fall in FEV1 post-EVH was not correlated with meanVe%MVV (rho=-0.03, p=0.72). There were no significant differences in age, sex, serum eosinophil and IgE levels or pre-EVH lung function between the groups (all p>0.05). However, the EVH+ group exhibited significantly lower baseline FEV1/FVC ratio and FEF25-75% (both p<0.05), higher rates of active smoking (9% vs 1%, p=0.01), history of atopy (62% vs 44%, p=0.02), inhaler treatments (56% vs 37%, p=0.02), and increased physician-assessed suspicion of asthma/EIB (p=0.008). Notably, 57% of the EVH+ group reported EVH-induced symptoms compared to 23% of the EVH-group (p<0.001). Among athletes, the highest positive EVH test prevalence (44%) was found in water sports participants (p=0.03 compared to track and winter sports participants). Conclusion In our cohort, meanVe%MVV was not related to the presence of a positive EVH. However, most subjects achieved a high meanVe%MVV value, suggesting the need for further studies examining different meanVe%MVV thresholds and their impact on test positivity in individuals with known asthma/EIB.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".