Use of heliox for acute asthma in the emergency department
- Report By: Michelle Jacobs - Specialist Registrar
- Search checked by Cilla Reid and John Butler - Consultant and Consultant in Emergency Medicine and Critical Care respectively
- Institution: East and North Herts NHS Trust
- Date Submitted: 2nd June 2003
- Date Completed: 1st July 2004
- Last Modified: 1st July 2004
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Status:
Green (complete)
Three Part Question
In [patients with an acute exacerbation of asthma] is [heliox] beneficial in [reducing the severity of the exacerbation]?Clinical Scenario
A 20 year old male attends the emergency department with a moderate to severe exacerbation of his asthma. HJe does not improve after repeated doses of nebulised salbutamol and atrovent. You have a feeling that heliox might be beneficial in just this sort of situation but wonder whether this is based on evidence or marketing hype.Search Strategy
Medline 1966-03/04 using the Ovid interface. The Cochrane Library Issue 1, 2004.[(asthma.mp OR exp asthma OR exp asthma, exercise-induced OR exp bronchial spasm OR broncospasm$.mp OR wheeze$.mp OR exp bronchial hyperreactivity
OR exp respiratory hypersensitivity OR status asthmaticus$.mp OR exp status asthmaticus OR acute asthma$.mp) AND (exp helium OR helium$.mp OR heliox$.mp OR (helium AND oxygen).mp)] LIMIT to human AND English language.
Cochrane: 'heliox'
Search Outcome
Altogether 207 papers were found, of which 6 were considered to be original research of high quality (randomised controlled trials) suitable for inclusion. Secondary citations from these papers were also scanned. These 6 papers have since been subject to meta-analysis by the Cochrane Review group. The Review was first published in 2000 with the most recent substantive amendment made in November 2002.Relevant Paper(s)
| Author, date and country | Patient group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Rodrigo G et al, 2004 | 6 RCTs including 369 patients with acute asthma (5 studies involving adults, 1 study dealing only with children) | Meta-analysis | Spirometric measurements (PEF L/min, PEF % predicted, FEV1 L, FEV1 % predicted) | Use of heliox did not improve pulmonary function compared with standard care (SMD=0.13; 95% CI: -0.09-0.34) | Surrogate endpoints |
Comment(s)
The individual trials examined in the Cochrane review vary widely in the type of patients recruited (age, severity of asthma), delivery of heliox and outcome measures. Outcomes vary between heliox having a beneficial effect and having no effect. There are very few side effects of heliox documented.Clinical Bottom Line
At the moment the evidence does not support the use of heliox in the emergency department treatment of acute asthma exacerbations.References
- Rodrigo G, Pollack C, Rodrigo C, et al. Heliox for nonintubated acute asthma patient. The Cochrane Library Issue 1, 2004. Oxford: Update Software.