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Original Research: COPD |

Helium-Hyperoxia: A Novel Intervention To Improve the Benefits of Pulmonary Rehabilitation for Patients With COPD

Neil D. Eves, PhD; Laura C. Sandmeyer, BSc; Eric Y. Wong, MD, FCCP; Lee W. Jones, PhD; Giles F. MacDonald, MD, FCCP; Gordon T. Ford, MD, FCCP; Stewart R. Petersen, PhD; Marc D. Bibeau, MD; Richard L. Jones, PhD
Author and Funding Information

*From the Faculty of Kinesiology and the Division of Respiratory Medicine (Dr. Eves), Faculty of Medicine, University of Calgary, Calgary, AB, Canada; the Caritas Centre for Lung Health (Ms. Sandmeyer and Dr. MacDonald), Edmonton General Continuing Care Centre, Edmonton, AB, Canada; the Pulmonary Division (Drs. Wong, Bibeau, and R.L. Jones), Department of Medicine, and the Faculty of Physical Education and Recreation (Dr. Petersen), University of Alberta, Edmonton, AB, Canada; the Department of Surgery (Dr. L.W. Jones), Duke University Medical Center, Durham, NC; and the Division of Respiratory Medicine (Dr. Ford), Faculty of Medicine, Rockyview General Hospital, Calgary, AB, Canada.

Correspondence to: Neil D. Eves, PhD, Faculty of Kinesiology and the Division of Respiratory Medicine, Faculty of Medicine, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada; e-mail: neves@ucalgary.ca


Dr. Ford has received honoraria and travel expenses for speaking at scientific meetings and continuing medical education courses from GlaxoSmithKline for $16,500 in 2005, $7,500 in 2006, and $14,000 in 2007. He has also received research funding from GlaxoSmithKline as a principal investigator for $135,000 between 2001–2005, Altana Pharma as a coinvestigator for $80,000 from 2004–2006, and $92,266 from GlaxoSmithKline, AstraZeneca, and Boehringer Ingelheim, Canada, Limited as a coinvestigator from 2004 to 2006. Dr. Ford has also received honoraria and travel expenses for participating on medical advisory boards for various pharmaceutical companies (GSK, AstraZeneca, and Boehringer Ingelheim, Canada, Limited, Altana Pharma, Pfizer Canada, and Abbott Canada). The other authors have no conflicts of interest to disclose.

Funding for this study was provided by the Medical Services Incorporated Foundation and the Caritas Health Group.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

For editorial comment see page 596


Chest. 2009;135(3):609-618. doi:10.1378/chest.08-1517
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Background:  Helium-hyperoxia (HH) reduces dyspnea and increases exercise tolerance in patients with COPD. We investigated whether breathing HH would allow patients to perform a greater intensity of exercise and improve the benefits of a pulmonary rehabilitation program.

Methods:  Thirty-eight nonhypoxemic patients with COPD (FEV1=47 ± 17%pred) were randomized to rehabilitation breathing HH (60:40 He:O2; n = 19) or air (n = 19). Patients cycled for 30 min, 3 days/week for 6 weeks breathing the assigned gas. Exercise intensity was prescribed from baseline, gas-specific, incremental exercise tests and was advanced as tolerated. The primary outcome was exercise tolerance assessed as a change in constant-load exercise time (CLT) following rehabilitation. Secondary outcomes were changes in exertional symptoms, health related quality of life (as assessed by the Short-form 36 and St George respiratory questionnaires), and peak oxygen consumption during an incremental exercise test.

Results:  The HH group had a greater change in CLT following rehabilitation compared to the air group (9.5 ± 9.1 vs 4.3 ± 6.3 min, p < 0.05). At an exercise isotime, dyspnea was significantly reduced in both groups, while leg discomfort only decreased in the HH group. The changes in exertional symptoms and peak oxygen consumption were not different between groups. Health-related quality of life significantly improved in both groups; however, the change in St. George respiratory questionnaire total score was greater with HH (−7.6 ± 6.4 vs –3.6 ± 5.6, p < 0.05). During rehabilitation, the HH group achieved a higher exercise intensity and training duration throughout the program (p < 0.05).

Conclusions:  Breathing HH during pulmonary rehabilitation increases the intensity and duration of exercise training that can be performed and results in greater improvements in CLT for patients with COPD.

Trial registration:  Clinicaltrials.gov Identifier: NCT00406705.

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