Chest
Clinical InvestigationsASTHMAA Pilot Prospective, Randomized, Placebo-Controlled Trial of Bilevel Positive Airway Pressure in Acute Asthmatic Attack
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one of them in the control group, could not tolerate the nasal mask and did not complete the 3-h protocol; they were withdrawn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)
- et al.
Randomized controlled trial of nasal ventilation in acute ventilation failure due to chronic obstructive airway disease
Lancet
(1993) - et al.
Noninvasive positive pressure ventilation via facemask: first-line intervention in patients with acute hypercapnic and hypoxemic respiratory failure
Chest
(1996) - et al.
Continuous positive airway pressure by face mask in acute cardiogenic pulmonary edema
Am J Cardiol
(1985) - et al.
Effect of nasal continuous positive airway pressure on methacholine-induced bronchoconstriction
Respir Med
(1995) - et al.
Cardiopulmonary responses to continuous positive airway pressure in acute asthma
J Crit Care
(1993) - et al.
Treatment of acute bronchospasm with beta-adrenergic agonist aerosols delivered by a nasal BiPAP circuit
Ann Emerg Med
(1995) - et al.
Treatment of bronchial asthma with terbutaline inhaled by cone spacer combined with positive expiratory pressure mask
Chest
(1991) - et al.
Noninvasive positive pressure ventilation in status asthmaticus
Chest
(1996) - et al.
Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease
N Engl J Med
(1995) - et al.
A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure
N Engl J Med
(1998)
Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask
N Engl J Med
Effect of noninvasive positive pressure ventilation on mortality in patients admitted with acute respiratory failure: a meta-analysis
Crit Care Med
Mechanical load and inspiratory muscle action during induced asthma
Am Rev Respir Dis
Mechanisms of hyperinflation in asthma
Eur Respir J
Cited by (268)
Evaluation and management of the critically ill adult asthmatic in the emergency department setting
2021, American Journal of Emergency MedicineBilevel Positive Airway Pressure ventilation efficiently improves respiratory distress in initial hours treating children with severe asthma exacerbation
2020, Journal of the Formosan Medical AssociationNoninvasive ventilation for acute exacerbations of asthma: A systematic review of the literature
2017, Australian Critical CareCritical Care Management of Severe Asthma Exacerbations
2024, Journal of Clinical Medicine