Background: Indirect provocation tests such as eucapnic voluntary hyperpnea challenge is recommended to objectively assess exercise-induced bronchoconstriction (EIB). A sport-specific field test with pre- and post-spirometry provides an alternative for assessing exercise-induced bronchoconstriction while replicating the conditions athletes typically experience. Aims: The aim of the present study was to compare the agreement of a eucapnic voluntary hyperpnea challenge and a one-hour intensive indoor swim training session to detect EIB in elite (>12 hours/week) and recreational (>1 hour/week) swimmers. Methods:70 athletes (45 elite/25 recreational) completed a six-minute eucapnic voluntary hyperpnea challenge with pre- and 3, 6, 10 and 15 minutes post-measurements of forced expiratory volume in one second. Participants later completed a one-hour indoor swim training session followed by six maximal effort swim intervals of 75m or 50m with pre- and 3, 6, 10 and 15 minutes post-spirometry. Swim intensity was measured by lactate, interval time, and subjective symptoms using visual analogue scales. Results:19 of 70 (27.1%) had exercise-induced bronchoconstriction after the eucapnic voluntary hyperpnea challenge, defined as two consecutive spirometry measurements with a >10% fall in forced expiratory volume in one second, compared to 1 (1.4%) after swim training. Bland-Altman analysis revealed a systematic mean difference of *9.53% (95% CI: *11.44 to *7.62%) or equivalently *0.43 L (95% CI: *0.52 to *0.34 L), with wide limits of agreement (*25.19% to +6.13%) and a large effect size (Cohen's d = *1.19). Sensitivity was 5.3% and specificity 100% with the eucapnic voluntary hyperpnea challenge as reference. Conclusion:The eucapnic voluntary hyperpnea challenge detected exercise-induced bronchoconstriction in 27.1% compared to 1.4% after intensive indoor swim training, indicating greater diagnostic sensitivity. The sport-specific test may underestimate exercise-induced bronchoconstriction, though results might differ with a different protocol.
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