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| |  Helium-Oxygen Shortens Treatment Time in Infants With Bronchiolitis: Presented at ERS By Evelyn Harvey VIENNA, Austria -- September 16, 2009 -- Infants with bronchiolitis require shorter treatment times when given a helium-oxygen (He + O2; Heliox) mixture instead of standard nitrogen-oxygen (N2 + O2; Airox) via a facemask. These benefits are particularly pronounced in infants with respiratory syncytial virus (RSV)-related disease, researchers announced here at the 19th Annual Congress of the European Respiratory Society (ERS). Heliox mixtures are thought to reduce the work of breathing by allowing greater laminar flow in the airways than do Airox mixtures. The physical properties of Heliox also encourages reinflation and improves both carbon dioxide clearance and oxygenation, explained Mohi Chowdhury, PhD, Imperial College, London, United Kingdom Imperial College, London, United Kingdom, describing results of the phase 3 Bronchiolitis RCT Emergency Assisted Therapy With Heliox Evaluation (BREATHE), here at a poster presentation on September 15. Dr. Chowdhury's team enrolled 319 infants aged 1 year or less in BREATHE; 160 were allocated to Heliox21 treatment (79% He + 21% O2) and 159 to Airox21 treatment (79% N2 + 21% O2), plus additional O2 as required. Patients requiring concomitant drug treatment, intubation, or tracheostomy were not included in the trial. Initial treatment delivery was via a tight-fitting 3-valve facemask with a reservoir bag. The 2 groups were further subdivided on the basis of facemask tolerance: 101 Airox and 96 Heliox patients were intolerant, and were switched to a nasal cannula. Nasal Continuous Positive Airway Pressure (nCPAP) was also used to deliver Heliox or Airox, if clinically indicated initially or due to deterioration of a patient's condition. The mean length of treatment did not differ overall between the treatment groups; however, significant effects were seen in the facemask-delivery subgroup, where Heliox therapy reduced mean treatment times from 2.006 days in the Airox group to 1.464 days (P = .031). Infants with RSV-associated bronchiolitis showed the greatest benefit from facemask-administered Heliox, with treatment times dropping from 2.455 days to 1.411 days (n = 58, P = .004). When compared with Airox, Heliox also appeared to reduce the need for nCPAP in patients with RSV (P = .06), and shortened treatment time in the 21 patients who required immediate nCPAP (P = .019). The use of a nasal cannula appears to abrogate the benefits of Heliox; this may be due to the mechanics of infant breathing incurring extra work with a nasal cannula. A total of 281 patients completed the study, with no significant differences in dropout rates between groups. Therapy with oxygen via Airox mixtures remains the standard treatment for bronchiolitis in infants. The BREATHE results demonstrate that Heliox therapy offers a potentially valuable alternative, reducing treatment times when administered via a suitable facemask. "We think this could eventually become the 'new oxygen,'" Dr. Chowdhury commented. The BREATHE study is the largest trial to date of Heliox therapy in infants with bronchiolitis. Further studies are needed to determine the effects of Heliox on the need for nCPAP, as the numbers in this trial were not sufficient for statistical significance. Funding for this study was provided by Linde Gas Therapeutics and Fisher and Paykel Healthcare. [Presentation title: Helium-Oxygen Gas Mixtures in Infants With Acute Bronchiolitis: Results of a Phase III Double-Blind, Multicentre RCT. Abstract P3998]
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