The need for standardization in exercise challenge testing for exercise-induced asthma/bronchoconstriction

Nine studies were reviewed and are summarized in Tables E3 and E4 (available in this article's Online Repository at www.jacionline.org).4-12 Combined, only 1 (11%) article followed all ATS-ECT guidelines.4 Three studies were rated as "unclear" because they failed to detail exercise intensity5 or no vigorous exercise was conducted before the ECT.6,7 Based on the published methodology, we determined that the remaining 5 (56%) studies did not follow ATS-ECT guidelines: room temperature13 or RH8,9,13,14 was too high, a nose clip was not used,10 the ECT duration was too long,11 or graded exercise was used.12 That the majority of studies failed to follow ATS-ECT guidelines is a significant concern when interpreting results of comparisons between an ECT and alternate diagnostic airway challenges. Because airway drying caused by increased minute ventilation is considered the primary trigger for EIA/EIB,1 any protocol in which exercise intensity is not appropriate would affect minute ventilation and corresponding stimulus for EIA/EIB.