Helium Inhalers in Respiratory Conditions

Technical and Administration Considerations

The American Thoracic Society notes that Heliox has lower density than ambient air, which can reduce resistance in large airways where flow is predominantly turbulent 1
Specialized delivery systems are required to maintain a gas-tight seal and prevent room air dilution, as standard oxygen masks lead to significant dilution by room air 2, 3
The use of Heliox is limited by the need for specialized delivery systems and the risk of inadequate oxygen delivery if not properly monitored 2, 4
The European Respiratory Society guidelines state that Heliox cannot be used if a patient requires more than 30% oxygen, as the helium mixture requires at least 70% helium for therapeutic effect 5, 6

The British Thoracic Society guidelines state that there is limited evidence of clinical benefit in most respiratory conditions, and Heliox does not reduce rates of intubation or length of mechanical ventilation in COPD or asthma patients 1, 7
The American College of Chest Physicians notes that Heliox does not demonstrate a reduction in mortality in patients with COPD or asthma 1
The European Respiratory Society guidelines recommend that Heliox not be used for routine clinical use outside of clinical trials 2
For asthma management, the American Academy of Allergy, Asthma, and Immunology states that there is limited evidence for benefit in severe asthma exacerbations, and Heliox may improve delivery of nebulized bronchodilators but meta-analyses do not support its use as initial treatment 5, 6, 8, 9
For COPD and hypercapnic respiratory failure, the American Thoracic Society notes that Heliox with non-invasive ventilation does not reduce intubation rates, duration of ventilatory support, or mortality in AECOPD 1

The British Thoracic Society guidelines state that Heliox affects the delivery of aerosolized treatments in complex ways, requiring specialized nebulizer systems 2
The American Thoracic Society notes that Heliox 80:20 mixture has similar oxygen content to air (21%), while Heliox 70:30 delivers higher FiO2 but is more dense due to higher oxygen content 2
Clinicians should aim to maintain appropriate oxygen saturation targets, such as 94-98% for patients with asthma or upper airway obstruction, and 88-92% for patients with severe COPD 2