Accuracy of eucapnic hyperpnea or mannitol to diagnose exercise-induced bronchoconstriction: a systematic review

Abstract

Exercise challenge testing is the typical method for diagnosing exercise induced bronchoconstriction; however, alternate tests have been developed. The purpose of this paper was to summarize the current literature comparing eucapnic voluntary hyperpnea and mannitol with standard exercise challenge testing to determine whether either test is a suitable alternative to standard exercise testing for the diagnosis of exercise-induced bronchoconstriction. Using valid systematic review methods, a comprehensive search strategy to avoid publication bias, we identified 10 studies that compared exercise challenge testing with either eucapnic voluntary hyperpnea or mannitol. For the 7 diagnostic cross-sectional studies that examined eucapnic voluntary hyperpnea, the sensitivity and specificity values were heterogeneous, ranging from 25 to 90% for sensitivity and 0 to 71% for specificity. In the 3 diagnostic cross-sectional studies that evaluated mannitol, the sensitivity and specificity ranged from 58 to 96% and 65 to 78%, respectively. For most studies, a representative spectrum of participants being tested was not used. Given the heterogeneity in sensitivity and specificity of eucapnic voluntary hyperpnea studies and the relatively small number of studies that have examined mannitol, insufficient evidence is available to conclude that either of these tests are suitable alternatives to exercise challenge testing to detect exercise-induced bronchoconstriction. Additional research is required.