Assessment of noninvasive ventilation in patients with acute severe asthma

Background
Despite improvements in asthma medication, intubation is deemed necessary in severe asthma with its complications. Noninvasive ventilation (NIV) is an evolving method to manage acute respiratory failure in those patients. However, the effect of NIV is unclear, and there are debates regarding its safety.


Aims
To evaluate the role of NIV in patients with acute severe asthma and to assess predictors for its use in those patients.


Patients and methods
In a prospective interventional study, 90 patients with acute asthma were divided into two groups: medical one and NIV group. The outcomes were the improvement in forced expiratory volume in the first second, as well as clinical and respiratory parameters.


Results
The respiratory rate showed a significant improvement after 6 h (16.6±3.7 breath/min), and also the heart rate (95.8±11.3 beat/min) and arterial partial pressure of oxygen (88.09±20.2). The time needed to alleviate accessory muscle use was shorter in the NIV group (1.93±0.3 vs. 3.07±0.4 h in the other group). The need for endotracheal intubation and invasive mechanical ventilation was more with group 1. There was no mortality in any group of our study.


Conclusion
NIV group demonstrated clinical improvement regarding the grade of dyspnea and accelerating the time needed for the absence of accessory muscle usage in acute severe asthma. NIV also has a significant benefit in improving oxygenation, lowering the intubation rate, and shortening the length of hospital and ICU stay in comparison with conventional medical therapy.