Abstract
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).
Footnotes
- Correspondence: Daniella C Brandão MSc, Department of Physiotherapy, Universidade Federal de Pernambuco, Ave Professor Moraes Rego, 1235 Cidade Universitária, Recife, Pernambuco 50670901 Brazil. E-mail: daniellacunha{at}hotmail.com.
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This research was partly supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, and by Conselho Nacional de Desenvolvimento Científico e Tecnológico.
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Ms Brandão presented a version of this paper at the European Respiratory Society Annual Congress, held September 13, 2009, in Vienna, Austria, and received a silver sponsorship from the European Respiratory Society.
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The authors have disclosed a relationship with White Martins Gases Industriais/Praxair.
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