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Meta-Analysis
. 2006 Oct 18;2006(4):CD002884.
doi: 10.1002/14651858.CD002884.pub2.

Heliox for nonintubated acute asthma patients

G Rodrigo  1 , C Pollack, C Rodrigo, B H Rowe
Affiliations
Meta-Analysis

Heliox for nonintubated acute asthma patients

G Rodrigo et al. Cochrane Database Syst Rev. .

Abstract

Background: Helium and oxygen mixtures (heliox), have been used sporadically in respiratory medicine for decades. Their use in acute respiratory emergencies such as asthma has been the subject of considerable debate. Despite the lapse of more than 60 years since it was first proposed, the role of heliox in treating patients with severe acute asthma remains unclear.

Objectives: To determine the effect of the addition of heliox to standard medical care on the course of acute asthma, as measured by pulmonary function testing and clinical endpoints.

Search strategy: Randomised controlled trials were identified from the Cochrane Airways Group Specialised Register. In addition, we contacted primary authors and experts and searched reference lists of articles. Searches are current to August 2005.

Selection criteria: 1) randomised, single or double blind, controlled trials; 2) children or adults with a clinical diagnosis of acute asthma seen in emergency departments or equivalent acute care settings; and 3) compared treatment with inhaled heliox to placebo (oxygen or air).

Data collection and analysis: Two review authors independently assessed the studies for inclusion and quality assessment; disagreement was resolved by a third review author and consensus.

Main results: This review has been updated in 2006 to include four new trials giving atotal of ten trials involving 544 acute asthma patients. Seven studies involved adults and three studies dealt solely with children. Three were assessed as high quality (Jadad score > 3). Pulmonary function tests were recorded during heliox administration (15 to 60 min). Pooling of the eight trials contributing data to this review showed no significant group differences (standardised mean differences -0.28; 95% confidence interval (CI) -0.56 to 0.01). There was significant heterogeneity among the studies. Heliox use did improve pulmonary function only in the subgroup of patients with the most severe baseline pulmonary function impairment; however, this conclusion is based on a small number of studies. There were no significant differences between groups when adults versus children, and high versus low heliox dose studies were compared. Finally, at the end of treatment, participants treated with heliox showed no significant different risk of admission to hospital (RR 0.83 (95%CI 0.66 to 1.08, P = 0.17, I(2) = 0%).

Authors' conclusions: The existing evidence does not provide support for the administration of helium-oxygen mixtures to all ED patients with acute asthma. At this time, heliox treatment does not have a role to play in the initial treatment of patients with acute asthma. Nevertheless, new evidence suggests certain beneficial effects in patients with more severe obstruction. Since these conclusions are based upon between-group comparisons and small studies, they should be interpreted with caution.

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Conflict of interest statement

The authors who have been involved in this review have done so without any known conflicts of interest. They are neither involved with the primary studies nor affiliated with any companies that produces heliox.

Figures

1
1
Funnel plot of the admission data.
1.1
1.1. Analysis
Comparison 1 Heliox therapy vs control (Pulmonary Function), Outcome 1 All studies.
1.2
1.2. Analysis
Comparison 1 Heliox therapy vs control (Pulmonary Function), Outcome 2 By Age.
1.3
1.3. Analysis
Comparison 1 Heliox therapy vs control (Pulmonary Function), Outcome 3 By Methodological Quality.
1.4
1.4. Analysis
Comparison 1 Heliox therapy vs control (Pulmonary Function), Outcome 4 By Dose.
1.5
1.5. Analysis
Comparison 1 Heliox therapy vs control (Pulmonary Function), Outcome 5 Method of heliox use.
1.6
1.6. Analysis
Comparison 1 Heliox therapy vs control (Pulmonary Function), Outcome 6 By baseline severity.
2.1
2.1. Analysis
Comparison 2 Heliox therapy vs control (Other outcomes), Outcome 1 Heart rate.
2.2
2.2. Analysis
Comparison 2 Heliox therapy vs control (Other outcomes), Outcome 2 SaO2.
2.3
2.3. Analysis
Comparison 2 Heliox therapy vs control (Other outcomes), Outcome 3 Dyspnea or Pulmonary index.
2.4
2.4. Analysis
Comparison 2 Heliox therapy vs control (Other outcomes), Outcome 4 Hospital admissions.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Carter 1996 {published data only}
    1. Carter ER, Webb CR, Moffitt DR. Evaluation of heliox in children hospitalized with acute severe asthma. A randomized crossover trial. Chest 1996;109:1256‐61. - PubMed
Dorfman 2000 {unpublished data only}
    1. Dorfman TA, Burton JH, Jones P, Shipley ER, Mette SA. Inhaled heliox does not benefit emergency department patients with moderate to severe asthma. American Journal of Emergency Medicine 2000;18:495‐7. - PubMed
Henderson 1999 {published data only}
    1. Henderson SO, Acharya P, Kilaghbian T, Perez J, Korn CS, Chan LS. Use of heliox‐driven nebulizer therapy in the treatment of acute asthma. Annals of Emergency Medicine 1999;33:141‐6. - PubMed
Kass 1999 {published data only}
    1. Kass EJ, Terregino CA. The effect of heliox in acute severe asthma. A randomized controlled trial. Chest 1999;116:296‐300. - PubMed
Kim 2005 {published data only}
    1. Kim IK, Phrampus E, Venkataraman S, et al. Helium/oxygen‐driven albuterol nebulization in the treatment of children with moderate to severe asthma exacerbations: A randomized, controlled trial. Pediatrics 2005;116:1127‐33. - PubMed
Kress 2002 {published data only}
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Lin Lee 2005a {published data only}
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Rivera 2006 {published data only}
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Rose 2002 {published data only}
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Xie 2003a {published data only}
    1. Xie L, Liu Y, Chen L, et al. Inhaling B2‐agonist with heliox‐driven in bronchial asthma. Chinese Medical Journal 2003;116:1011‐5. - PubMed

References to studies excluded from this review

Bag 2002 {published data only}
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L'Her 2000 {published data only}
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Lin Lee 2005b {published data only}
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Shiue 1989 {published data only}
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Verbeek 1998 {published data only}
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Xie 2003b {published data only}
    1. Xie L, Liu Y, Chen L, Hao F, Jin G, Zhao H. Inhaling beta(2)‐agonist with heliox‐driven in bronchial asthma. Chinese Medical Journal 2003;116(7):1011‐5. - PubMed

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References to other published versions of this review

Rodrigo 2001
    1. Rodrigo G, Rodrigo C, Pollack C, Travers A. Helium‐oxygen mixture for nonintubated acute asthma patients. Cochrane Database of Systematic Reviews 2001, Issue 1. [DOI: 10.1002/14651858.CD002884] - DOI - PubMed