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Published ahead of print on July 13, 2006, doi:10.1164/rccm.200509-1533OC

Am. J. Respir. Crit. Care Med., Volume 174, Number 7, October 2006, 763-771

A more recent version of this article appeared on October 1, 2006
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Submitted on September 29, 2005
Accepted on July 7, 2006

Helium-Hyperoxia, Exercise and Respiratory Mechanics in Chronic Obstructive Pulmonary Disease

Neil D Eves1*, Stewart R Petersen1, Mark J Haykowsky2, Eric Y Wong3, and Richard L Jones3

1 Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada, 2 Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada, 3 Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada

* To whom correspondence should be addressed. E-mail: neves{at}ucalgary.ca.

Rationale: Hyperoxia and normoxic-helium independently reduce dynamic hyperinflation and improve the exercise tolerance of patients with chronic obstructive pulmonary disease (COPD). Combining these gases could have an additive effect on dynamic hyperinflation and a greater impact on respiratory mechanics and exercise tolerance. Objective: To investigate whether helium-hyperoxia improves the exercise tolerance and respiratory mechanics of COPD patients. Methods: Ten males with COPD (FEV1 = 47 ±17%pred [mean±SD]) performed randomized constant-load cycling at 60% maximal work rate breathing air, hyperoxia (40%O2, 60%N2), normoxic-helium (21%O2, 79%He) or helium-hyperoxia (40%O2, 60%He). Measurements: Exercise time, inspiratory capacity (IC), work of breathing and exertional symptoms were measured with each gas. Results: Compared to air (9.4 ± 5.2 min), exercise time was increased with hyperoxia (17.8 ± 5.8 min) and normoxic-helium (16.7 ± 9.1 min) but the improvement with helium-hyperoxia (26.3 ± 10.6 min) was greater than both these gases (p=0.019 and p=0.007, respectively). At an isotime during exercise, all three gases reduced dyspnea and both helium mixtures increased IC and tidal volume. Only helium-hyperoxia significantly reduced the resistive work of breathing (15.8 ± 4.2 vs. 10.1 ± 4.1 L.cm H2O-1) and the work to overcome intrinsic positive end-expiratory pressure (7.7 ± 1.9 vs. 3.6 ± 2.1 L.cm H2O-1). At symptom-limitation, tidal volume remained augmented with both helium mixtures but IC and the work of breathing were unchanged compared to air. Conclusion: Combining helium and hyperoxia delays dynamic hyperinflation and improves respiratory mechanics, which translates into added improvements in exercise tolerance for patients with COPD.
Key words: Dynamic Hyperinflation, Dyspnea, Work of Breathing, Pulmonary Function, Expiratory Flow Limitation




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