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Effect of Heliox Breathing on Dynamic Hyperinflation in COPD Patients^*

^* From the Istituto di Fisiologia Umana I (Drs. Pecchiari and Edgardo D’Angelo), Dipartimento di Pediatria (Dr. Emanuela D’Angelo), Università di Milano, Milan, Italy; Servizio di Fisiopatologia Respiratoria (Drs. Pelucchi and Foresi), Ospedale di Sesto San Giovanni, Sesto San Giovanni, Milan, Italy; and Meakins-Christie Laboratories (Dr. Milic-Emili), McGill University, Montreal, QC, Canada.

Correspondence to: Edgardo D’Angelo, MD, Istituto di Fisiologia Umana I, via Mangiagalli 32, 20133 Milan, Italy; e-mail: edgardo.dangelo{at}unimi.it

Background and objective: Patients with COPD exhibit increased inspiratory work and dyspnea due to dynamic hyperinflation caused by expiratory flow limitation. Helium-oxygen mixtures (ie, heliox) have been used in treating these patients on the assumption that, by lowering airway resistance, they might be beneficial.

Methods: In 22 patients with COPD, the presence of expiratory flow limitation was assessed with patients in the sitting and supine positions using the negative expiratory pressure technique, and the effects of heliox (80% He, 20% O2) on breathing pattern, expiratory flow limitation, and dynamic hyperinflation, evaluated from the change in inspiratory capacity (IC), were measured at rest and were compared with those due to inhaled salbutamol.

Results: During air breathing, 13 patients experienced flow limitation while in the sitting position and 18 experienced flow limitation while in the supine position. Neither heliox nor salbutamol therapy changed the breathing pattern in any of the patients, regardless of posture and the presence or absence of expiratory flow limitation. However, in both positions IC increased significantly in most flow-limited patients after bronchodilator administration, but not after heliox administration.

Conclusions: Since heliox had no effect on dynamic hyperinflation, the use of this gas mixture, which is costly and cumbersome, does not appear to be beneficial in stable patients with COPD breathing at rest.

Key Words: breathing pattern • bronchodilator • density dependence • expiratory flow limitation • negative expiratory pressure technique • respiratory mechanics

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