Asthma · Non-invasive ventilation in acute asthma
Bilevel positive airway pressure in severe acute asthma
| Design | Pilot prospective, randomised, placebo-controlled trial |
|---|---|
| Treatment | Bilevel positive airway pressure added to conventional treatment |
| Control | Sham device plus conventional treatment |
| Population | 30 patients presenting with a severe asthma attack |
| Follow-up | Emergency department stay and admission decision |
| Primary endpoint | Increase of at least 50% in FEV1 from baseline |
| Result | The primary endpoint was reached by 80% of the bilevel group versus 20% of controls (p<0.004). Mean FEV1 rise was 53.5±23.4% versus 28.5±22.6% (p=0.006). Hospitalisation was required for 3 of 17 (17.6%) versus 10 of 16 (62.5%) in the intention-to-treat analysis. |
| Secondary endpoints | Rate of hospitalisation, symptom resolution |
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.
The trial authors, in the published abstract
A pilot trial of 30 patients whose effect size — admissions from 62.5% to 17.6% — has never been convincingly replicated at scale. Non-invasive ventilation in acute asthma remains a reasonable option in selected patients rather than standard care, and the fear of barotrauma in severely obstructed lungs keeps enthusiasm in check.
Soroksky A, Stav D, Shpirer I. A pilot prospective, randomized, placebo-controlled trial of bilevel positive airway pressure in acute asthmatic attack. Chest 2003 Apr;123(4):1018-25.