Chest
Volume 135, Issue 3, March 2009, Pages 609-618
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Original Research
COPD
Helium-Hyperoxia: A Novel Intervention To Improve the Benefits of Pulmonary Rehabilitation for Patients With COPD

https://doi.org/10.1378/chest.08-1517Get rights and content

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.

Section snippets

Patients

Patients with stable COPD (post bronchodilator FEV1/FVC < 0.7, FEV1<80% predicted) who were exacerbation-free for > 1 month prior to study entry were recruited from the Caritas Centre for Lung Health, Edmonton, Canada. Patients were excluded if they had cardiovascular and/or musculoskeletal contraindications that limited exercise participation and if they had exertional hypoxemia indicated by an oxyhemoglobin saturation < 85% during any of the preliminary exercise trials breathing air. All

Results

Participant flow through the study is presented in detail in Figure 1. Patients were enrolled between March 2005 and November 2006. Of the 441 patients who were referred to rehabilitation, the main reasons for excluding patients were: patients had diseases other than COPD (121/441), patients were on supplemental O2 (73/441), patients declined rehabilitation (71/441), patients had cardiovascular disease that limited their ability to perform exercise (32/441), patients had known exertional

Discussion

This is the first study to investigate the effect of breathing HH during rehabilitation in patients without hypoxemia and with COPD. This proof-of-concept study supports the hypothesis that HH can augment the known benefits of a comprehensive pulmonary rehabilitation program, as CLT and total SGRQ score improved more following rehabilitation with HH than with the standard practice of rehabilitation breathing air.

The greater increase in CLT in the HH group supports our hypothesis that if a

Acknowledgment

The authors thank Monica Pratley, Sharon Martin, Tina Jourdain, Lindsay Simmonds, Rashida Hamir, and Barb Gendron for their support with all aspects of the study.

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  • Cited by (0)

    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).

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    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.

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