The Effect of Heliox in Acute Severe Asthma

Kass, Jonathan; Terregino, Carol A.

doi:10.1378/chest.116.2.296

Cited by 124 publications

(57 citation statements)

References 18 publications

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“…While the effects of air density at altitude have not been addressed in the asthma literature, the density issue has received attention in the management of asthma at sea level. Numerous studies have looked at the use of a lowdensity helium-oxygen mixture (heliox) in nonintubated patients with asthma exacerbations and have revealed improvements in dyspnoea and airflow obstruction [141], spirometric parameters such as FVC and FEV1 [142] and delivery of nebulised solutions to the lower airways [143]. Some systematic reviews [144,145] have concluded, however, that the preponderance of evidence does not yet support the widespread use of heliox in clinical practice.…”

Section: Air Densitymentioning

confidence: 99%

Travel to high altitude with pre-existing lung disease

Luks

Swenson²

2007

European Respiratory Journal

105

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The pathophysiology of high-altitude illnesses has been well studied in normal individuals, but little is known about the risks of high-altitude travel in patients with pre-existing lung disease. Although it would seem self-evident that any patient with lung disease might not do well at high altitude, the type and severity of disease will determine the likelihood of difficulty in a high-altitude environment. The present review examines whether these individuals are at risk of developing one of the main forms of acute or chronic high-altitude illness and whether the underlying lung disease itself will get worse at high elevations. Several groups of pulmonary disorders are considered, including obstructive, restrictive, vascular, control of ventilation, pleural and neuromuscular diseases. Attempts will be made to classify the risks faced by each of these groups at high altitude and to provide recommendations regarding evaluation prior to high-altitude travel, advice for or against taking such excursions, and effective prophylactic measures.

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Section: Air Densitymentioning

confidence: 99%

Travel to high altitude with pre-existing lung disease

Luks

Swenson²

2007

European Respiratory Journal

105

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“…1,2 Heliox is a mixture of helium and oxygen that reduces air-flow turbulence, compared to air or oxygen. [3][4][5][6] The use of heliox in asthma treatment was first reported in 1935. 7 However, few controlled studies have been carried out concerning heliox's impact on hospitalization in patients with acute asthma who do not respond to traditional treatment.…”

Section: Introductionmentioning

confidence: 99%

Heliox and Forward-Leaning Posture Improve the Efficacy of Nebulized Bronchodilator in Acute Asthma: A Randomized Trial

et al. 2011

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BACKGROUND: Heliox and forward-leaning posture (torso inclined forward at 50 -60°with the elbows resting on the thighs) are adjuncts in the administration of nebulized bronchodilator to patients with acute asthma. METHODS: We randomized 59 patients who presented to the emergency department in severe asthma crisis, into 4 treatment groups: nebulized bronchodilator ؉ oxygen; nebulized bronchodilator ؉ oxygen ؉ forward-leaning posture; nebulized bronchodilator ؉ heliox; and nebulized bronchodilator ؉ heliox ؉ forward-leaning posture. Before and after the bronchodilator treatments the subjects were seated with torso erect, breathing room air. Each subject received 2 doses, 20 min apart, of nebulized fenoterol (2.5 mg) plus ipratropium bromide (0.25 mg) in 3 mL of 0.9% saline, delivered with a semi-closed valved aerosol reservoir. The nebulizer was run with oxygen or 80:20 heliox. The post-treatment pulmonary function tests were performed 15 min after the second nebulization. The group's mean age was 35.1 ؎ 13.6 y, and there were 20 men and 39 women. RESULTS: The oxygen ؉ forward-leaning-posture group had a greater FEV 1 improvement than the oxygen group (59% vs 38%, P ‫؍‬ .02). The heliox ؉ forwardleaning-posture group had a greater FEV 1 improvement than the oxygen group (103% vs 38%, P ‫؍‬ .001) and the heliox group (103% vs 42%, P ‫؍‬ .03). The heliox group had greater reduction in respiratory rate than the oxygen group (P ‫؍‬ .03). The heliox ؉ forward-leaning-posture group had significantly greater peak expiratory flow improvement than any of the other groups. CON-CLUSIONS: Heliox plus forward-leaning posture during bronchodilator nebulization improves bronchodilator efficacy in patients with severe acute asthma. (ClinicalTrials.gov registration NCT00922350).

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“…These properties lead to improved laminar gas flow in the bronchi, resulting in increased oxygenation of the alveoli and decreased carbon dioxide retention. Clinically, this has been reported in several studies as a more rapid fall in PaCO 2 with helium/oxygen mixtures than with conventional therapy (Swidwa et al 1985;Oelberg et al, 1998;Jolliet et al, 1999;Kass and Terregino, 1999;Jaber et al, 2000). In this present study, blood gas analysis was not carried out and, therefore, PaCO 2 values are unknown.…”

Section: Discussionmentioning

confidence: 77%

A double-blind, randomised, controlled Phase II trial of Heliox28 gas mixture in lung cancer patients with dyspnoea on exertion

et al. 2004

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Helium has a low density and the potential of reducing the work of breathing and improving alveolar ventilation when replacing nitrogen in air. A Phase II, double-blind, randomised, prospective, controlled trial was undertaken to assess whether Heliox28 (72% He/28% O 2 ) compared with oxygen-enriched air (72% N 2 /28% O 2 ) or medical air (78.9% N 2 /21.1% O 2 ) could reduce dyspnoea and improve the exercise capability of patients with primary lung cancer and dyspnoea on exertion (Borg 43). A total of 12 patients (seven male, five female patients, age 53 -78) breathed the test gases in randomised order via a facemask and inspiratory demand valve at rest and while performing 6-min walk tests. Pulse oximetry (SaO 2 ) was recorded continuously. Respiratory rate and dyspnoea ratings (Borg and VAS) were taken before and immediately post-walk. Breathing Heliox28 at rest significantly increased SaO 2 compared to oxygen-enriched air (9672 cf. 9472, Po0.01). When compared to medical air, breathing Heliox28 but not oxygen-enriched air gave a significant improvement in the exercise capability (Po0.0001), SaO 2 (Po0.05) and dyspnoea scores (VAS, Po0.05) of lung cancer patients.

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The Effect of Heliox in Acute Severe Asthma

Cited by 124 publications

References 18 publications

Travel to high altitude with pre-existing lung disease

Travel to high altitude with pre-existing lung disease

Heliox and Forward-Leaning Posture Improve the Efficacy of Nebulized Bronchodilator in Acute Asthma: A Randomized Trial

A double-blind, randomised, controlled Phase II trial of Heliox28 gas mixture in lung cancer patients with dyspnoea on exertion

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