Effect of Heliox- and Air-Driven Nebulized Bronchodilator Therapy on Lung Function in Patients with Asthma

El-Khatib, Mohamad; Jamaleddine, Ghassan; Kanj, Nadim; Zeineddine, Salah; Chami, Hassan; Akl, Imad Bou; Husari, Ahmad; Alawieh, Marwan; Bou‐Khalil, Pierre

doi:10.1007/s00408-014-9570-0

Cited by 16 publications

(23 citation statements)

References 26 publications

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“…For example, deBoisblanc and colleagues (52) failed to demonstrate an improvement in FEV 1 when using helioxdriven bronchodilator therapy instead of air-driven therapy in COPD patients with acute exacerbations. Similarly, ElKhatib and colleagues (53) showed no significant improvement in pulmonary function test parameters in mild and moderate asthmatics between heliox-driven and air-driven bronchodilator therapy, although significant improvements were seen in severe asthmatcis (FEV 1 < 50%pred). Thus, to this date, clinical trials on the use of heliox in inhalation therapy have not been definitive.…”

Section: Parameters Affecting Addmentioning

confidence: 99%

Bridging the Gap Between Science and Clinical Efficacy: Physiology, Imaging, and Modeling of Aerosols in the Lung

Darquenne

Fleming

Katz

et al. 2016

Journal of Aerosol Medicine and Pulmonary Drug Delivery

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Development of a new drug for the treatment of lung disease is a complex and time consuming process involving numerous disciplines of basic and applied sciences. During the 2015 Congress of the International Society for Aerosols in Medicine, a group of experts including aerosol scientists, physiologists, modelers, imagers, and clinicians participated in a workshop aiming at bridging the gap between basic research and clinical efficacy of inhaled drugs. This publication summarizes the current consensus on the topic. It begins with a short description of basic concepts of aerosol transport and a discussion on targeting strategies of inhaled aerosols to the lungs. It is followed by a description of both computational and biological lung models, and the use of imaging techniques to determine aerosol deposition distribution (ADD) in the lung. Finally, the importance of ADD to clinical efficacy is discussed. Several gaps were identified between basic science and clinical efficacy. One gap between scientific research aimed at predicting, controlling, and measuring ADD and the clinical use of inhaled aerosols is the considerable challenge of obtaining, in a single study, accurate information describing the optimal lung regions to be targeted, the effectiveness of targeting determined from ADD, and some measure of the drug's effectiveness. Other identified gaps were the language and methodology barriers that exist among disciplines, along with the significant regulatory hurdles that need to be overcome for novel drugs and/or therapies to reach the marketplace and benefit the patient. Despite these gaps, much progress has been made in recent years to improve clinical efficacy of inhaled drugs. Also, the recent efforts by many funding agencies and industry to support multidisciplinary networks including basic science researchers, R&D scientists, and clinicians will go a long way to further reduce the gap between science and clinical efficacy.

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Section: Parameters Affecting Addmentioning

confidence: 99%

Bridging the Gap Between Science and Clinical Efficacy: Physiology, Imaging, and Modeling of Aerosols in the Lung

Darquenne

Fleming

Katz

et al. 2016

Journal of Aerosol Medicine and Pulmonary Drug Delivery

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“…Heliox is the name given to a gaseous mixture of helium and oxygen that has been used medically since the 1930s and is used to alleviate both upper and lower airway obstruction in people . Flow through obstructed airways is turbulent, requiring increased effort to reach the desired tidal volume.…”

Section: Introductionmentioning

confidence: 99%

“…Brachycephalic dogs have naturally occurring airway obstruction. Their features are described by the term brachycephalic airway obstructive syndrome (BAOS) and include stenotic nares, elongated soft palate, nasopharyngeal turbinates, everted laryngeal saccules, laryngeal collapse, and hypoplastic trachea . These anatomic features cause characteristic changes in brachycephalic breathing patterns that can be identified with pulmonary function testing, including tidal breathing flow‐volume loops (TBFVL) .…”

Section: Introductionmentioning

confidence: 99%

The effect of inhaled heliox on peak flow rates in normal and brachycephalic dogs

Benavides

Rozanski

Anastasio

et al. 2018

Veterinary Internal Medicne

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BackgroundHeliox, a mixture of helium and oxygen, alleviates airway obstruction in people and improves air flow, and its use has been proposed in dogs. Brachycephalic dogs have naturally occurring airway obstruction where heliox might be a useful therapeutic option.ObjectiveThe purposes of this study were to (1) determine the impact of breathing heliox on peak inspiratory and expiratory flows (PIF/PEF) in healthy dogs and (2) determine if brachycephalic dogs and mesocephalic dogs have similar responses to inhaled heliox.AnimalsEleven healthy dogs: 5 mesocephalic and 6 brachycephalic dogs.MethodsA prospective study. Tidal breathing flow‐volume loops were recorded when dogs were breathing room air (nitrogen‐oxygen) and heliox. Peak inspiratory and expiratory flow rates were recorded and the subjective shape of loops assessed. Peak inspiratory and expiratory flows pre‐ and post‐heliox were compared using a Mann‐Whitney Rank sum test with a P‐value of <.05 considered significant.ResultsIn inhaled heliox, PIF and PEF were evaluated by tidal breathing flow‐volume loops. In mesocephalic dogs, PIF increased from a median of 820 mL/s (range, 494‐1010 mL/s) to 1386 mL/s; P = .02; and for PEF from 688 mL/s to 1793 mL/s (P = .04), whereas in brachycephalic dogs, the median PIF increased from 282 mL/s to 694 mL/s; P = .01 and the median PEF increased from 212 mL/s to 517 mL/sec; P = .03. Brachycephalic dogs showed normalization of loop shapes.Conclusions and clinical importanceHeliox improves flow rate and appears to improve flow patterns in brachycephalic dogs.

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“…[3][4][5][6] Most previous studies have examined the use of heliox in non-intubated subjects who were breathing spontaneously or with the support of noninvasive ventilation. [7][8][9][10][11] A review of studies involving subjects with acute asthma concluded that breathing heliox appeared to improve pulmonary function but had no effect on the rate of hospital admission. 7 Instead of simply breathing heliox, the latter can also be used to deliver bronchodilators by nebulization.…”

Section: Introductionmentioning

confidence: 99%

“…7 Instead of simply breathing heliox, the latter can also be used to deliver bronchodilators by nebulization. 8,9 Heliox-driven nebulization of albuterol has been shown to enhance its bronchodilator effect, 8 and may reduce the rate of hospitalization of asthma patients treated in the emergency department. 9 The use of heliox in subjects with exacerbations of COPD who required noninvasive ventilation has been evaluated in 2 large, multi-center randomized trials.…”

Section: Introductionmentioning

confidence: 99%

Lack of Benefit of Heliox During Mechanical Ventilation of Subjects With Severe Air-Flow Obstruction

2017

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BACKGROUND: The value of heliox (helium-oxygen mixture) for patients with severe air-flow obstruction is uncertain. The purpose of this study was to determine whether heliox could reduce the degree of hyperinflation and hypercapnia in mechanically ventilated patients with severe airflow obstruction. METHODS: This was a single-center, prospective observational study conducted in a medical ICU of an academic medical center. We assessed the impact of heliox (65-70% helium, 30 -35% oxygen) on airway pressures and arterial blood gases of 13 subjects undergoing mechanical ventilation for severe asthma (n ‫؍‬ 8) or exacerbation of COPD (n ‫؍‬ 5). RESULTS: As compared with ventilation with air-O 2 , heliox resulted in a reduction in peak airway pressure (54.1 ؎ 12.6 cm H 2 O vs 47.9 ؎ 10.8 cm H 2 O, P < .001) and P aCO 2 (64.3 ؎ 14.9 mm Hg vs 62.3 ؉ 15.1 mm Hg, P ‫؍‬ .01). In contrast, there was no change in plateau pressure (25.3 ؎ 5.5 cm H 2 O vs 25.8 ؎ 5.6 cm H 2 O, P ‫؍‬ .14) or total PEEP (13.4 ؎ 3.8 cm H 2 O vs 13.3 ؎ 4.1 cm H 2 O, P ‫؍‬ .79) in response to heliox. CONCLUSIONS: In mechanically ventilated subjects with severe air-flow obstruction, administration of heliox had no effect on indices of dynamic hyperinflation (plateau pressure and total PEEP) and resulted in only a small reduction in P aCO 2 .

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Effect of Heliox- and Air-Driven Nebulized Bronchodilator Therapy on Lung Function in Patients with Asthma

Abstract: Improvements in PFT variables are more frequent and profound with heliox-driven compared to air-driven bronchodilator therapy only in asthmatic patients with baseline FEV(1) ≤50 %.

Cited by 16 publications

References 26 publications

Bridging the Gap Between Science and Clinical Efficacy: Physiology, Imaging, and Modeling of Aerosols in the Lung

Bridging the Gap Between Science and Clinical Efficacy: Physiology, Imaging, and Modeling of Aerosols in the Lung

The effect of inhaled heliox on peak flow rates in normal and brachycephalic dogs

Lack of Benefit of Heliox During Mechanical Ventilation of Subjects With Severe Air-Flow Obstruction

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