Published ahead of print on January 26, 2006, doi:10.1164/rccm.200506-925OC
Am. J. Respir. Crit. Care Med., Volume 173, Number 8, April 2006, 865-870
A more recent version of this article appeared on April 15, 2006
Submitted on June 15, 2005
Accepted on January 24, 2006
The Effect of Helium and Oxygen on Exercise Performance in COPD: a Randomised Crossover Trial
Elizabeth A Laude1*, Nicholas C Duffy2, Chloe Baveystock3, Beatriz Dougill4, Michael J Campbell5, Rod Lawson6, Paul W Jones3, and Peter M Calverley2
1 Department of Respiratory Medicine, Royal Hallamshire Hospital, Sheffield, United Kingdom; Department of Biomedical Science, University of Sheffield, Sheffield, United Kingdom,
2 Department of Clinical Sciences, University Hospital Aintree, Liverpool, United Kingdom,
3 St. George's, University of London, London, United Kingdom,
4 BOC Ltd, Guildford, United Kingdom,
5 Department of General Practice and Primary Care, ScHARR, University of Sheffield, Sheffield, United Kingdom,
6 Department of Respiratory Medicine, Royal Hallamshire Hospital, Sheffield, United Kingdom
* To whom correspondence should be addressed. E-mail: e.a.laude{at}sheffield.ac.uk.
Rationale -Breathing supplemental oxygen reduces breathlessness during exercise in COPD patients. Replacing Nitrogen with Helium reduces expiratory flow resistance and may improve lung emptying. Combining these treatments should be independently effective.
Objectives - to study the effect of changing oxygen and/or helium concentration in inspired gas during exercise, in stable COPD patients.
Methods -In 82 patients (mean age 69.7 years, mean FEV1, 42.6% predicted), we measured endurance shuttle walking distance, resting and exercise oxygen saturation and end-exercise dyspnea (Borg scale) whilst breathing Heliox28 (72% He/28% O2), Heliox21 (79% He/21%O2), Oxygen28 (72% N2/28% O2) or medical air (79% N2/21% O2). Gases were administered, using a randomised, blinded, cross-over design, via a face-mask and an inspiratory demand valve.
Results-Breathing Heliox28 increased walking distance (mean ±SD, 147 ± 150 m) and reduced Borg score (-1.28 ± 1.30) more than any other gas mixture. Heliox21 significantly increased walking distance (99 ± 101 m) and reduced dyspnea (Borg score -0.76 ± 0.77) compared to medical air. These changes were similar to those breathing Oxygen28. The effects of helium and oxygen in Heliox28 were independent. The increase in walking distance whilst breathing Heliox28 was inversely related to baseline FEV1 breathing air.
Conclusion -Reducing inspired gas density can improve exercise performance in COPD as much as increasing inspired oxygen. These effects can be combined as Heliox28 and are most evident in patients with more severe airflow obstruction.
Key words: COPD, helium, oxygen, exercise capacity
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