2003 OPEN FORUM Abstracts
THE UTILITY OF ALBUTEROL NEBULIZED WITH HELIOX DURING ACUTE ASTHMA EXACERBATIONS.
John P. Kress, Imre Noth, Brian K. Gehlbach, Anne S. Pohlman, Sherwin Morgan and Jesse B. Hall
Department of Medicine, University of Chicago, Chicago, Illinois
Correspondence: Correspondence and requests for reprints should be addressed to Jesse B. Hall, M.D., University of Chicago, Section of Pulmonary and Critical Care Medicine, 5841 South Maryland Avenue, MC 6026, Chicago, IL 60637.
Heliox improves lung deposition of inhaled particles when compared with air or oxygen inhalation. We previously studied the spirometric effects of albuterol nebulized with heliox during emergency room visits for asthma exacerbations. Forty-five patients were randomized to receive albuterol nebulized with oxygen (control) versus heliox (n = 22 control and 23 heliox subjects). Three consecutive albuterol treatments were given to each group. The heliox group had a significantly higher heart rate after albuterol nebulization compared with the control group. Following albuterol Treatment 1, the median change in forced expiratory volume in one second was 14.6% in the control group and 32.4% in the heliox group (p =0.007). After Treatment 2, the results were 22.7% versus 51.5%, respectively (p = 0.007). After Treatment 3, the results were 26.6% versus 65.1%, respectively (p = 0.016). We concluded that during acute asthma exacerbations, albuterol nebulized with heliox leads to a more significant improvement in spirometry when compared with albuterol nebulized with oxygen. This is likely due to the low-density gas improving albuterol deposition in the distal airways.
Post study testing of the nebulizer device (RES-Q-Neb® ) was performed at an independent testing laboratory (Cardinal Health in Research Triangle Park, N.C.) The testing measured particle sizes and percent respirable fraction of albuterol using the heliox RES-Q-Neb® system as compared to a conventional albuterol nebulizer using compressed air. The results are listed in the tables below.
Comparison of Heliox 10 LPM (plus Reservoir bag 10 LPM), Heliox 18 LPM (plus Reservoir bag 18 LPM) and Compressed Air 10 LPM-One Way Analysis of Variance
|Heliox 10 LPM||Heliox 18 LPM||Compressed Air 10 LPM||P value|
|Percent Respirable Fraction||28.9 +/- 1.2||30.8 +/- 1.9||18.2 +/- 1.0||< 0.001|
Post hoc analysis using of One Way ANOVA using Student-Newman-Keuls Method
|Comparison||Difference of Mean Percent Respirable Fraction||P value|
|Heliox 10 LPM vs. Heliox 18 LPM||1.9%||0.14|
|Heliox 10 LPM vs. Compressed Air 10 LPM||10.7%||< 0.001|
|Heliox 18 LPM vs. Compressed Air 10 LPM||12.7%||< 0.001|
We conclude that nebulized albuterol is delivered more efficiently with heliox as the driving gas and therefore supporting the conclusion that not only did the low-density gas improving albuterol deposition in the distal airways, but delivered the albuterol drug particles in a greater respirable range.