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Communications to the Editor |

Heliox Effect or Rapid-Onset Acute Severe Asthma FREE TO VIEW

Gustavo J. Rodrigo, MD; Carlos Rodrigo, MD
Author and Funding Information

Montevideo, Uruguay

Correspondence to: Gustavo J. Rodrigo, MD, Department de Emergencia, Hospital Central de las FF. AA. Av 8 de Octubre 3020, Montevideo 11600, Uruguay; e-mail: gurodrig@adinet.com.uy



Chest. 2000;117(4):1212. doi:10.1378/chest.117.4.1212
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Published online

To the Editor:

We read with great interest the article by Kass and Terregino that appeared in the August 1999 issue of CHEST.1In this article, the authors conducted a randomized controlled study to evaluate the effect of heliox on airflow obstruction and dyspnea in adult patients with acute severe asthma. The authors concluded that “heliox rapidly improves airflow obstruction and dyspnea in patients with acute severe asthma and may be useful as a therapeutic bridge until the corticosteroid effect occurs.” Through a close inspection of the entry data, we found that the heliox group presented an important (statistically nonsignificant) difference in the mean duration of attack prior to emergency department presentation (32.6 vs 51.1 h). Accordingly, the heliox group is composed of patients with a more rapid-onset asthma than the control group. Additionally, it is well known that rapid-onset asthmatic patients exhibit a more severe asthma at presentation and a quick recovery compared with slow-onset asthma patients.25 The study data are congruent with this idea. Thus, heliox group patients appear more severe at presentation (peak expiratory flow, 120.9 vs 140.0 L/min; dyspnea score, 6.18 vs 4.04; respiratory rate, 30.1 vs 24.3 breaths/min; heart rate, 115.4 vs 104.6 beats/min), and had a fast recovery. Because the authors did not remove the bias introduced by that difference at the initial level, their conclusions appear doubtful. Consequently, the patient’s improvement could be due to that factor.

References

Kass, JE, Terregino, CA (1999) The effect of heliox in acute severe asthma: a randomized controlled trial.Chest116,296-300. [PubMed] [CrossRef]
 
Arnold, AG, Lane, DJ, Zapata, E The speed of onset and severity of acute severe asthma.Br J Dis Chest1982;76,157-163. [PubMed]
 
Goto, E, Okamoto, I, Tanaka, K The clinical characteristics at the onset of a severe asthma attack and the effects of high frequency jet ventilation for severe asthmatic patients.Eur J Emerg Med1998;5,451-455. [PubMed]
 
Kolbe, J, Fergusson, W, Garret, J Rapid onset asthma: a severe but uncommon manifestation.Thorax1998;53,241-247. [PubMed]
 
Woodruff, PG, Emond, SD, Singh, AK, et al Sudden-onset severe asthma: clinical features and response to therapy.Acad Emerg Med1998;5,695-701. [PubMed]
 

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Tables

References

Kass, JE, Terregino, CA (1999) The effect of heliox in acute severe asthma: a randomized controlled trial.Chest116,296-300. [PubMed] [CrossRef]
 
Arnold, AG, Lane, DJ, Zapata, E The speed of onset and severity of acute severe asthma.Br J Dis Chest1982;76,157-163. [PubMed]
 
Goto, E, Okamoto, I, Tanaka, K The clinical characteristics at the onset of a severe asthma attack and the effects of high frequency jet ventilation for severe asthmatic patients.Eur J Emerg Med1998;5,451-455. [PubMed]
 
Kolbe, J, Fergusson, W, Garret, J Rapid onset asthma: a severe but uncommon manifestation.Thorax1998;53,241-247. [PubMed]
 
Woodruff, PG, Emond, SD, Singh, AK, et al Sudden-onset severe asthma: clinical features and response to therapy.Acad Emerg Med1998;5,695-701. [PubMed]
 
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