TY - JOUR T1 - Heliox and Forward-Leaning Posture Improve the Efficacy of Nebulized Bronchodilator in Acute Asthma: A Randomized Trial JF - Respiratory Care SP - 947 LP - 952 DO - 10.4187/respcare.00963 VL - 56 IS - 7 AU - Daniella C Brandão AU - Murilo C Britto AU - Maira F Pessoa AU - Rafaela B de Sá AU - Luciana Alcoforado AU - Leonardo O Matos AU - Thayse N Silva AU - Armèle Dornelas de Andrade Y1 - 2011/07/01 UR - http://rc.rcjournal.com/content/56/7/947.abstract N2 - 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). ER -