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Heliox Treatment: Effective for Children with Asthma?

Heliox delivery of albuterol improved asthma symptoms significantly compared with oxygen delivery, but this finding’s clinical significance is not clear.

Heliox (helium/oxygen mixture) might be superior to oxygen as a driving gas for aerosol delivery of ß-agonists in patients with acute asthma because its lower gas density results in decreased flow resistance and increased lung penetration. In a randomized controlled trial, researchers compared heliox versus oxygen for delivery of continuous nebulized albuterol in 30 children aged 2 to 18 years with moderate to severe asthma exacerbations. The study was partially sponsored by a supplier of medical heliox.

Patients received nebulized albuterol and oral corticosteroids at presentation, followed by continuous albuterol (15 mg/hour) with either 100% oxygen or 70%:30% helium/oxygen for 1 hour. Heliox was titrated to maintain oxygen saturation 93%; treatment failures received 100% oxygen. An unblinded investigator assessed patients every 30 minutes; after each hour, all patients but those with the mildest symptoms received an additional hour of therapy, up to a total of 3 hours. Disposition decisions were made at the 4-hour mark.

The two groups were similar at baseline. Mean change in pulmonary index score from baseline to 240 minutes was 6.7 (from 10.7 to 4.2) in the heliox group and 3.3 (from 9.7 to 6.5) in the oxygen group (P<0.001). The difference in scores was statistically significant starting at 125 minutes. Eleven heliox patients and five oxygen patients were discharged home by 12 hours (P<0.05). No discharged patient sought ED or primary care for relapse within 7 days.

Comment: This well-designed, well-executed trial showed that heliox delivery of ß-agonists yielded greater improvement in asthma symptoms than oxygen delivery. However, most patients in both groups ended up with mild symptoms at the end of the study, calling into question the clinical significance of the finding. A study powered to detect a difference in hospital admission or other clinically significant endpoints is needed before heliox delivery becomes standard treatment for acute asthma.

— Jill M. Baren, MD, FACEP, FAAP

Published in Journal Watch Emergency Medicine January 31, 2006

Citation(s):

Kim IK et al. Helium/oxygen-driven albuterol nebulization in the treatment of children with moderate to severe asthma exacerbations: A randomized, controlled trial. Pediatrics 2005 Nov; 116:1127-33.

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