The efficacy of inhalation therapy with a thermal helium-oxygen mixture in patients with severe exacerbations of asthma

Vollständiger Abstract

Worum geht es in dieser Arbeit?

According to the current paradigm of Global Initiative for Asthma (GINA, 2026), the principal goal of treating patients with asthma is to achieve and maintain complete control of the disease. The level of asthma control directly determines the frequency and severity of exacerbations, the majority of which occur in patients with severe, partly controlled, or uncontrolled disease. Severe acute asthma exacerbations (SAAE) account for up to 10 – 20% of all annual asthma exacerbations and usually require hospitalization and complex therapy, including methods of respiratory support. New therapeutic approaches aimed at optimizing the management of patients with SAAE are being actively explored. One promising avenue is the use of a thermal helium–oxygen mixture (t-He/O 2 ) as a component of inhalation therapy. The aim was to evaluate the efficacy and safety of t-He/O inhalations as part of complex therapy in patients with SAAE and a long-standing history of severe asthma, in comparison with SAAE therapy administered in accordance with current clinical guidelines alone. Methods . The study included 26 patients with SAAE: 15 patients of the main group, who received inhalation t-He/O 2 therapy in combination with the standard therapy, and 11 patients of the control group, who received standard therapy alone. Inhalations were performed for 10 – 15 min twice daily as a 10-day course. The dynamics of vital signs (respiratory rate, heart rate, blood pressure, SpO 2 measured by pulse oximetry), clinical symptoms, pulmonary ventilation parameters (peak expiratory flow (PEF), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1 / FVC), arterial blood gases (PaO 2 , PaCO 2 , SaO 2 ), acidbase balance (pH, HCO 3 –, base excess (BE), lactate), central hemodynamics (deviation of volemic status from normal, stroke index (SI), left ventricular ejection fraction (EF), cardiac output (CO), tidal volume (Vt)) and the oxygen delivery system (CaO 2 , DO 2 I) were assessed before treatment and after completion of the course. The safety and tolerability of t-He/O 2 were evaluated using adverse-event registration logs and individual patient diaries. The Mann – Whitney U-test was used for comparisons between independent groups, the Wilcoxon signed-rank test for within-group dynamics, and Fisher’s exact test for categorical variables. Results . By day 10 of treatment, the main group, which received complex therapy combined with t-He/O 2 inhalations, demonstrated statistically significant differences from the control group in the rate and magnitude of dyspnea reduction and in the improvement of pulmonary function (PEF (p = 0.016), FEV1 (p = 0.026), FVC (p = 0.002)), arterial blood gases (PaO 2 (p < 0.001), SaO 2 (p = 0.026), PaCO 2 (p < 0.001)) and acid–base balance (pH (p = 0.003), lactate (p = 0.038)). Significant between-group differences in favor of the main group were also observed for tidal volume (Vt) and for the oxygen transport system (CaO 2 , DO 2 I), as well as for key hemodynamic parameters (SI), whereas the therapy had no significant effect on cardiac output, left ventricular ejection fraction, or the deviation of volemic status from normal. Treatment with t-He/O 2 was characterized by a high safety profile and good tolerability. Conclusion . The use of t-He/O 2 as part of the complex therapy of SAAE contributes to a more pronounced and more rapid reduction of clinical symptoms, resolution of respiratory failure, effective restoration of pulmonary ventilation and gas exchange, correction of metabolic disturbances, and improved oxygenation and oxygen transport without imposing an additional load on the pumping function of the heart. The inclusion of t-He/O 2 in the complex therapy of SAAE is safe and is characterized by good tolerability.