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Best evidence topic reports
Use of heliox for acute asthma in the emergency department
Free
  1. Michelle Jacobs, Specialist Registrar,
  2. Cilla Reid, Consultant,
  3. John Butler, Consultant
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jonesman.ac.uk

    Abstract

    A short cut review was carried out to establish whether heliox is of benefit in patients with an exacerbation of asthma resistant to standard treatments. Eighteen papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this best paper are tabulated. A clinical bottom line is stated.

    http://dx.doi.org/10.1136/emj.2004.016535

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      Report by Michelle Jacobs,Specialist Registrar 
 Checked by Cilla Reid, Consultant, 
 John Butler, Consultant

      Clinical scenario

      A 20 year old man attends the emergency department with a moderate to severe exacerbation of his asthma. He 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.

      Three part question

      In [patients with an acute exacerbation of asthma] is [heliox] beneficial in [reducing the severity of the exacerbation]?

      Search strategy

      Medline 1966-03/04 using the Ovid interface. The Cochrane Library Issue 1, 2004.

      Medline: [(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 six were considered to be original research of high quality (randomised controlled trials) suitable for inclusion. Secondary citations from these papers were also scanned. These six 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 (see table 2).

      View this table:
      Table 2

      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 reported.

      CLINICAL BOTTOM LINE

      At the moment the evidence does not support the use of heliox in the emergency department treatment of acute asthma exacerbations.

      Report by Michelle Jacobs,Specialist Registrar 
 Checked by Cilla Reid, Consultant, 
 John Butler, Consultant

      References

      1. ↵
        Rodrigo G, Pollack C, Rodrigo C, et al. Heliox for nonintubated acute asthma patients. Cochrane Library. Issue 1. Oxford: Update Software, 2004.