Chest
Volume 123, Issue 4, April 2003, Pages 1018-1025
Journal home page for Chest

Clinical Investigations
ASTHMA
A Pilot Prospective, Randomized, Placebo-Controlled Trial of Bilevel Positive Airway Pressure in Acute Asthmatic Attack

https://doi.org/10.1378/chest.123.4.1018Get rights and content

Study objective:

Noninvasive ventilation has been shown to be effective in patients with acute respiratory failure due to pulmonary edema and exacerbations of COPD. Its role in an acute asthmatic attack, however, is uncertain. The purpose of this pilot study was to compare conventional asthma treatment with nasal bilevel pressure ventilation (BPV) [BiPAP; Respironics; Murrysville, PA] plus conventional treatment in patients with a severe asthmatic attack admitted to the emergency department.

Design:

A prospective, randomized, placebo-controlled study.

Setting:

An emergency department at a university hospital.

Patients:

Thirty patients with a severe asthma attack were recruited from a larger group of 124 asthmatic patients seen in the emergency department. Fifteen patients were randomly assigned to BPV plus conventional therapy and 15 patients to conventional therapy alone. The two groups had similar clinical characteristics on hospital admission. Mean (± SD) FEV1 on recruitment was 37.3 ± 10.7% in the BPV group and 33.8 ± 10.2% in the control group (p = not significant).

Interventions and measurements:

BPV with predetermined inspiratory and expiratory pressures was applied for 3 h in the BPV group; in the control group, a similar sham device with subtherapeutic pressures was applied for 3 h. Bedside lung function test results and vital signs were obtained at baseline, and during and at the completion of the study protocol.

Results:

The use of BPV significantly improved lung function test results. Eighty percents of the patients in the BPV group reached the predetermined primary end points (an increase of at least 50% in FEV1 as compared to baseline), vs 20% of control patients (p < 0.004). Mean rise in FEV1 was 53.5 ± 23.4% in the BPV group and 28.5 ± 22.6% in the conventional treatment group (p = 0.006). The intention-to-treat analysis of the secondary end point rate of hospitalization included 33 patients. Hospitalization was required for 3 of 17 patients (17.6%) in the BPV group, as compared with 10 of 16 patients (62.5%) in the control group (p = 0.0134).

Conclusion:

In selected patients with a severe asthma attack, the addition of BPV to conventional treatment can improve lung function, alleviate the attack faster, and significantly reduce the need for hospitalization.

Section snippets

Study Design and Patient Selection

The study was approved by the Institutional Ethics Committee and by the National Helsinki committee. All patients gave written informed consent. Between November 1999 and April 2000, we screened all adults aged 18 to 50 years with an acute attack of bronchial asthma, who presented at the emergency department of Asaf Harofe Medical Center, with an asthma attack of < 7 days in duration and a history of asthma of at least 1 year.

On admission to the emergency department, all patients judged by the

Results

During the study period, a total of 124 asthmatic patients were seen at the emergency department. Two patients had pneumonia, and 85 patients presented with an FEV1 > 60% of predicted; therefore, these patients were excluded. Thirty-seven patients (29.8%) fulfilled the severe asthma inclusion criteria, and 4 patients refused to participate in the study. Three patients, one of them in the control group, could not tolerate the nasal mask and did not complete the 3-h protocol; they were withdrawn

Discussion

This study shows that the use of noninvasive ventilatory support in the form of BPV in selected patients with a severe attack of asthma can alleviate the attack faster, improve lung function test results more completely—namely FEV1, FVC, and PEFR—and prevent hospitalizations. Although the use of noninvasive ventilation in treating respiratory failure in cardiogenic pulmonary edema and COPD has been shown to be effective,1234567 its role in asthma has not been established.

Prior reports indicate

References (28)

  • AD Bersten et al.

    Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask

    N Engl J Med

    (1991)
  • SP Keenan et al.

    Effect of noninvasive positive pressure ventilation on mortality in patients admitted with acute respiratory failure: a meta-analysis

    Crit Care Med

    (1997)
  • JG Martin et al.

    Mechanical load and inspiratory muscle action during induced asthma

    Am Rev Respir Dis

    (1983)
  • Y Cormier et al.

    Mechanisms of hyperinflation in asthma

    Eur Respir J

    (1990)
  • Cited by (268)

    View all citing articles on Scopus
    View full text