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Evaluation of heliox in children hospitalized with acute severe asthma. A randomized crossover trial
E R Carter1, C R Webb, D R Moffitt
1Division of Pediatric Pulmonology, Madigan Army Medical Center, Tacoma, Wash 98410-5000, USA.
Insights
Short-term heliox inhalation did not improve pulmonary function or reduce symptoms in children hospitalized with severe asthma. This study found no significant benefits for breathing heliox compared to air in this pediatric patient group.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Critical Care
Background:
- Acute severe asthma in children requires effective treatment strategies.
- Heliox, a helium-oxygen gas mixture, has been explored for its potential to improve airflow in obstructive lung diseases.
Purpose of the Study:
- To evaluate the efficacy of heliox in improving pulmonary function and clinical outcomes in hospitalized children with acute severe asthma.
Main Methods:
- A prospective, randomized, double-blind, crossover study was conducted.
- Children aged 5-18 years with acute severe asthma received heliox and a 30% oxygen-enriched air mixture for 15 minutes each.
- Pulmonary function tests (FVC, FEV1, PEFR, FEF25-75), clinical scores, and dyspnea scores were assessed.
Main Results:
- While heliox showed a statistically significant improvement in Peak Expiratory Flow Rate (PEFR) and Mean Mid-expiratory Flow Rate (FEF25-75), it did not significantly improve Forced Vital Capacity (FVC) or Forced Expiratory Volume in 1 second (FEV1).
- No significant differences were observed in clinical scores or dyspnea scores between heliox and air inhalation.
- Eleven children completed the study, with no significant differences between baseline and end-study spirometry values.
Conclusions:
- Short-term inhalation of heliox did not provide significant clinical benefits for children hospitalized with acute, severe asthma.
- The observed minor improvements in PEFR and FEF25-75 with heliox were not clinically substantial enough to alter overall patient outcomes.
Study Objective:
To determine whether breathing a blend of 70% helium:30% oxygen (heliox) would improve pulmonary function, decrease clinical score, and improve the sensation of dyspnea in children hospitalized with acute severe asthma.
Design:
Prospective, randomized, double-blind, crossover study.
Setting:
The inpatient pediatric service of a military, tertiary care, teaching hospital.
Patients:
Children 5 to 18 years who required hospital admission for treatment of acute asthma.
Interventions:
All patients received 5 mg of nebulized albuterol every 1 to 4 h, with a dose given within 30 min of the start of the study, and IV administered methylprednisolone. Patients breathed heliox and a 30% oxygen-enriched air mixture for 15 min each in random order.
Measurements And Results:
Clinical score, dyspnea score, oxygen saturation, heart rate, and respiratory rate, followed by FVC, FEV1, peak expiratory flow rate (PEFR), and, mean midexpiratory flow rate (FEF25-75) were obtained at study entry, 15 min after breathing the first gas mixture (heliox or air per randomization), 15 min after breathing the second mixture, and again 15 min after stopping the second gas mixture (study end values). Eleven children were enrolled, and all completed the study. There were no significant differences between study entry and study end spirometric values. Using the paired t test, we found no significant differences between mean values (SD) of FEV1 and FVC obtained while breathing heliox vs air; FEV1-heliox, 53% (18%) of the predicted value; FEV1-air, 52% (16%) of the predicted value (p = 0.36); FVC-heliox, 69% (22%) of the predicted value; and FVC-air, 70% (21%) of the predicted value (p = 0.50). The differences in values for PEFSR and FEF25-75 while breathing heliox vs air were small but did reach statistical significance in favor of heliox: PEFR-heliox, 56% (20%) of the predicted value; PEFR-air, 50% (16%) of the predicted value (p = 0.04); FEF25-75-heliox, 32% (13%) of the predicted value; and FEF25-75-heliox, 29% (11%) of the predicted value (p = 0.006). Heliox had no effect on either clinical or dyspnea scores.
Conclusion:
The short-term inhalation of heliox did not benefit this group of children hospitalized with acute, severe asthma.