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

Authors: Brandão, Daniella C1; Britto, Murilo C2; Pessoa, Maira F1; de Sá, Rafaela B1; Alcoforado, Luciana1; Matos, Leonardo O1; Silva, Thayse N1; de Andrade, Armèle Dornelas1

Source: Respiratory Care, Volume 56, Number 7, July 2011 , pp. 947-952(6)

Publisher: The Journal Respiratory Care Company

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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 FEV1 improvement than the oxygen group (59% vs 38%, P = .02). The heliox + forward-leaning-posture group had a greater FEV1 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. CONCLUSIONS: Heliox plus forward-leaning posture during bronchodilator nebulization improves bronchodilator efficacy in patients with severe acute asthma. (ClinicalTrials.gov registration NCT00922350).

Keywords: asthma; bronchodilator; heliox; helium; posture; respiratory muscles

Document Type: Research Article

DOI: http://dx.doi.org/10.4187/respcare.00963

Affiliations: 1: Department of Physiotherapy, Federal University of Pernambuco, Recife City, Brazil 2: Instituto Materno Infantil de Pernambuco, Recife City, Brazil

Publication date: July 1, 2011

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