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Randomised controlled trial of high concentration versus titrated oxygen therapy in severe exacerbations of asthma
  1. Kyle Perrin1,2,
  2. Meme Wijesinghe1,2,
  3. Bridget Healy1,2,
  4. Kirsten Wadsworth1,
  5. Richard Bowditch1,2,
  6. Susan Bibby1,2,
  7. Tanya Baker1,
  8. Mark Weatherall2,3,
  9. Richard Beasley1,2,3
  1. 1Medical Research Institute of New Zealand, Wellington, New Zealand
  2. 2Departments of Respiratory and Medicine and Emergency Medicine, Capital & Coast District Health Board, Wellington, New Zealand
  3. 3Department of Medicine,University of Otago Wellington, Wellington, New Zealand
  1. Correspondence to Professor Richard Beasley, Medical Research Institute of New Zealand, Private Bag 7902, Wellington 6242, New Zealand; richard.beasley{at}


Background The effect on Paco2 of high concentration oxygen therapy when administered to patients with severe exacerbations of asthma is uncertain.

Methods 106 patients with severe exacerbations of asthma presenting to the Emergency Department were randomised to high concentration oxygen (8 l/min via medium concentration mask) or titrated oxygen (to achieve oxygen saturations between 93% and 95%) for 60 min. Patients with chronic obstructive pulmonary disease or disorders associated with hypercapnic respiratory failure were excluded. The transcutaneous partial pressure of carbon dioxide (Ptco2) was measured at 0, 20, 40 and 60 min. The primary outcome variable was the proportion of patients with a rise in Ptco2 ≥4 mm Hg at 60 min.

Results The proportion of patients with a rise in Ptco2 ≥4 mm Hg at 60 min was significantly higher in the high concentration oxygen group, 22/50 (44%) vs 10/53 (19%), RR 2.3 (95% CI 1.2 to 4.4, p<0.006). The high concentration group had a higher proportion of patients with a rise in Ptco2 ≥8 mm Hg, 11/50 (22%) vs 3/53 (6%), RR 3.9 (95% CI 1.2 to 13.1, p=0.016). All 10 patients with a final Ptco2 ≥45 mm Hg received high concentration oxygen therapy, and in five there was an increase in Ptco2 ≥10 mm Hg.

Conclusion High concentration oxygen therapy causes a clinically significant increase in Ptco2 in patients presenting with severe exacerbations of asthma. A titrated oxygen regime is recommended in the treatment of severe asthma, in which oxygen is administered only to patients with hypoxaemia, in a dose that relieves hypoxaemia without causing hyperoxaemia.

Clinical trial number ACTRN12607000131459.

  • Carbon dioxide
  • oxygen
  • asthma
  • randomised controlled trial

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Supplementary materials

  • Web Only Data thx.2010.155259

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  • See Editorial, p 931

  • Linked article 161497.

  • Funding Funding was received from the Health Research Council of New Zealand, the Wellington Hospitals and Health Foundation, the Asthma and Respiratory Foundation of New Zealand and the Royal Australasian College of Physicians.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Central Regional Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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