The efficacy of inhalation therapy with a thermal helium-oxygen mixture in patients with severe exacerbations of asthma

According to the current paradigm of Global Initiative for Asthma (GINA, 2026), the principal goal of treating patients with asthma is to achieve and maintain complete control of the disease. The level of asthma control directly determines the frequency and severity of exacerbations, the majority of which occur in patients with severe, partly controlled, or uncontrolled disease. Severe acute asthma exacerbations (SAAE) account for up to 10 – 20% of all annual asthma exacerbations and usually require hospitalization and complex therapy, including methods of respiratory support. New therapeutic approaches aimed at optimizing the management of patients with SAAE are being actively explored. One promising avenue is the use of a thermal helium–oxygen mixture (t-He/O₂) as a component of inhalation therapy. The aim was to evaluate the efficacy and safety of t-He/O inhalations as part of complex therapy in patients with SAAE and a long-standing history of severe asthma, in comparison with SAAE therapy administered in accordance with current clinical guidelines alone. Methods. The study included 26 patients with SAAE: 15 patients of the main group, who received inhalation t-He/O₂ therapy in combination with the standard therapy, and 11 patients of the control group, who received standard therapy alone. Inhalations were performed for 10 – 15 min twice daily as a 10-day course. The dynamics of vital signs (respiratory rate, heart rate, blood pressure, SpO₂ measured by pulse oximetry), clinical symptoms, pulmonary ventilation parameters (peak expiratory flow (PEF), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1 / FVC), arterial blood gases (PaO₂, PaCO₂, SaO₂), acidbase balance (pH, HCO₃–, base excess (BE), lactate), central hemodynamics (deviation of volemic status from normal, stroke index (SI), left ventricular ejection fraction (EF), cardiac output (CO), tidal volume (Vt)) and the oxygen delivery system (CaO₂, DO₂I) were assessed before treatment and after completion of the course. The safety and tolerability of t-He/O₂ were evaluated using adverse-event registration logs and individual patient diaries. The Mann – Whitney U-test was used for comparisons between independent groups, the Wilcoxon signed-rank test for within-group dynamics, and Fisher’s exact test for categorical variables. Results. By day 10 of treatment, the main group, which received complex therapy combined with t-He/O₂ inhalations, demonstrated statistically significant differences from the control group in the rate and magnitude of dyspnea reduction and in the improvement of pulmonary function (PEF (p = 0.016), FEV1 (p = 0.026), FVC (p = 0.002)), arterial blood gases (PaO₂ (p < 0.001), SaO₂ (p = 0.026), PaCO₂ (p < 0.001)) and acid–base balance (pH (p = 0.003), lactate (p = 0.038)). Significant between-group differences in favor of the main group were also observed for tidal volume (Vt) and for the oxygen transport system (CaO₂, DO₂I), as well as for key hemodynamic parameters (SI), whereas the therapy had no significant effect on cardiac output, left ventricular ejection fraction, or the deviation of volemic status from normal. Treatment with t-He/O₂ was characterized by a high safety profile and good tolerability. Conclusion. The use of t-He/O₂ as part of the complex therapy of SAAE contributes to a more pronounced and more rapid reduction of clinical symptoms, resolution of respiratory failure, effective restoration of pulmonary ventilation and gas exchange, correction of metabolic disturbances, and improved oxygenation and oxygen transport without imposing an additional load on the pumping function of the heart. The inclusion of t-He/O₂ in the complex therapy of SAAE is safe and is characterized by good tolerability.

1. Venkatesan P. 2026 GINA report for asthma. Lancet Respir. Med. 2026: S2213-2600(26)00188-8 (Epub ahead of print). DOI: 10.1016/s2213-2600(26)00188-8.

2. Ministry of Health of the Russian Federation. [Clinical guidelines: Bronchial asthma]. 2024. Available at: https://spulmo.ru/upload/KR-bronhialnaya-astma-2024.pdf (in Russian).

3. Rance K., Young B., McCreary G. et al. The global patient perspective on uncontrolled moderate-to-severe asthma: reducing delays in diagnosis and treatment. Adv. Ther. 2025; 42 (12): 6045–6058. DOI: 10.1007/s12325-025-03346-w.

4. National Center of Environmental Health (NCEH) – Centers for Disease Control and Prevention (CDC). Uncontrolled asthma among adults, 2019. Available at: https://www.cdc.gov/asthma/asthma_stats/uncontrolled-asthma-adults-2019.htm

5. Kraposhina A.Yu., Sobko E.A., Demko I.V. et al. [Difficult-to-treat asthma: the most significant factors impeding control]. Byulleten' fiziologii i patologii dykhaniya. 2024; (91): 23–33. DOI: 10.36604/1998-5029-2024-91-23-33 (in Russian).

6. Bateman E.D., Busse W., Pedersen S.E. et al. Global Initiative for Asthma 2016 – derived asthma control with fluticasone propionate and salmeterol: a Gaining Optimal Asthma Control (GOAL) study reanalysis. Ann. Allergy Asthma Immunol. 2019; 123 (1): 57–63.e2. DOI: 10.1016/j.anai.2019.04.018.

7. Chipps B.E., Zeiger R.S., Borish L. et al. Key findings and clinical implications from the epidemiology and natural history of asthma: outcomes and treatment regimens (TENOR) study. J. Allergy Clin. Immunol. 2012; 130 (2): 332–342. DOI: 10.1016/j.jaci.2012.04.014.

8. Moore W.C., Bleecker E.R., Curran-Everett D. et al. Characterization of the severe asthma phenotype by the national heart, lung, and blood institute's severe asthma research program. J. Allergy Clin. Immunol. 2007; 119 (2): 405–413. DOI: 10.1016/j.jaci.2006.11.639.

9. Rodriguez-Roisin R. Acute severe asthma: pathophysiology and pathobiology of gas exchange abnormalities. Eur. Respir. J. 1997; 10 (6): 1359–1371. DOI: 10.1183/09031936.97.10061359.

10. Hess D.R., Fink J.B., Venkataraman S.T. et al. The history and physics of heliox. Respir. Care. 2006; 51 (6): 608–612. DOI: 10.4187/respcare.06510608.

11. Whitsett J.A. Airway epithelial differentiation and mucociliary clearance. Ann. Am. Thorac. Soc. 2018;15 (Suppl. 3): S143–148. DOI: 10.1513/AnnalsATS.201802-128AW.

12. Jesenak M., Durdik P., Oppova D. et al. Dysfunctional mucociliary clearance in asthma and airway remodeling – New insights into an old topic. Respir. Med. 2023; 218: 107372. DOI: 10.1016/j.rmed.2023.107372.

13. Hashemian S.M., Fallahian F. The use of heliox in critical care. Int. J. Crit. Illn. Inj. Sci. 2014; 4 (2): 138–142. DOI: 10.4103/2229-5151.134153.

14. Kass J.E., Castriotta R.J. Heliox therapy in acute severe asthma. Chest. 1995; 107 (3): 757–760. DOI: 10.1378/chest.107.3.757.

15. Russian Respiratory Society. [Guidelines: use of thermal Heliox (t-He/O₂) in the treatment of patients with respiratory insufficiency (respiratory distress syndrome)]. 2018. Available at: https://spulmo.ru/download/geliox2018.pdf?ysclid=ms35bznlfq322175659 (in Russian).

16. Chyong T., Shogenova L. [The use of helium–oxygen mixture for respiratory diseases]. Prakticheskaya pul'monologiya. 2021; (1): 74–79 Доступно на: https://atmosphere-ph.ru/modules/Magazines/articles//pulmo/pp_1_2021_74.pdf (in Russian).

17. Nguyen V.T., Soldatov D.G. [Relationship between airway smooth muscle and asthma: the role of temperature in the treatment]. Pul'monologiya. 2026; 36 (1): 71–83. DOI: 10.18093/0869-0189-2026-36-1-71-83 (in Russian).

18. Varfolomeev S.D., Panin A.A., Ryabokon' A.M. et al. [Thermal heliox proteome. High-temperature heliox does not cause destruction of human respiratory system cells]. Terapevticheskiy arkhiv. 2020; 92 (6): 69–72. Available at: https://ter-arkhiv.ru/0040-3660/article/view/34988/23420 (in Russian).

19. MedTechInnovations [User manual for the Heliox-extreme device]. 2015. Available at: https://docs.nevacert.ru/files/med_reestr_v2/10197_instruction.pdf (in Russian).

20. Graham B.L., Steenbruggen I., Miller M.R. et al. Standardization of spirometry 2019 update. An Official American Thoracic Society and European Respiratory Society Technical Statement. Am. J. Respir. Crit. Care Med. 2019; 200 (8): e70–88. DOI: 10.1164/rccm.201908-1590ST.

21. Nowak K., Szpot P., Zawadzki M. Suicidal deaths due to helium inhalation. Forensic Toxicol. 2019; 37 (2): 273–287. DOI: 10.1007/s11419-019-00473-2.

22. Rodrigo G.J., Pollack C.V., Rodrigo C., Rowe B.H. Heliox for nonintubated acute asthma patients. Cochrane Database Syst. Rev. 2006 (4): CD002884. DOI: 10.1002/14651858.CD002884.pub2.

23. Shogenova L.V., Petrikov S.S., Zhuravel S.V. et al. [Thermal helium-oxygen mixture as part of a treatment protocol for patients with COVID-19. Vestnik Rossiyskoy akademii meditsinskikh nauk. 2020; 75 (S5): 353–362. DOI: 10.15690/vramn1412 (in Russian).

24. Shogenova L.V. [Efficacy and safety of combined therapy with thermal heliox and nitric oxide during noninvasive ventilation in patients with acute chronic obstructive pulmonary disease complicated by hypoxemic, hypercapnic respiratory failure and secondary pulmonary hypertension]. Consilium Medicum. 2025; 27: 159–164. DOI: 10.26442/20751753.2025.3.203177 (in Russian).

25. Kravchenko N.Yu., Molostova T.N., Belevsky A.S. et al. [Specific characteristics of exacerbation development in patients with different phenotypes of severe asthma]. RMZh. Meditsinskoe obozrenie. 2023; 7 (2): 96–102. DOI: 10.32364/2587-6821-2023-7-2-96-102 (in Russian).

26. Rodrigo G.J., Castro-Rodriguez J.A. Heliox-driven β2-agonists nebulization for children and adults with acute asthma: a systematic review with meta-analysis. Ann. Allergy Asthma Immunol. 2014; 112 (1): 29–34. DOI: 10.1016/j.anai.2013.09.024.

27. Kass J.E., Terregino C.A. The effect of heliox in acute severe asthma: a randomized controlled trial. Chest. 1999; 116 (2): 296–300. DOI: 10.1378/chest.116.2.296.

28. Loshkareva E.O. [Combined use of thermogeliox and nebulizer therapy in patients with bronchial asthma: dissertation]. Moscow; 2011.