Is Continuous Positive Airway Pressure (CPAP) used to treat asthma?

From the Guidelines

CPAP is not typically used to treat asthma, as it is primarily designed to treat obstructive sleep apnea by delivering a constant flow of pressurized air to keep airways open during sleep. Asthma, on the other hand, is an inflammatory condition of the airways that requires different treatment approaches, including inhaled corticosteroids (like fluticasone, budesonide), bronchodilators (such as albuterol, salmeterol), and sometimes oral medications like montelukast or prednisone 1. These medications address the underlying inflammation and bronchoconstriction characteristic of asthma. In severe asthma exacerbations requiring hospitalization, other respiratory support methods like oxygen therapy, nebulized medications, or in critical cases, mechanical ventilation might be used, but standard CPAP is not part of routine asthma management. The reason for this difference in treatment approaches is that asthma involves reversible airway obstruction due to inflammation and muscle constriction, while sleep apnea involves physical collapse of the upper airway during sleep, which CPAP specifically addresses by maintaining positive pressure.

Key points to consider:

• CPAP is the standard treatment for obstructive sleep apnea (OSA), but not for asthma 1
• Asthma treatment focuses on reducing inflammation and bronchoconstriction, whereas CPAP is designed to prevent airway collapse during sleep
• Alternative therapies for OSA, such as mandibular advancement devices, may be considered for patients who cannot tolerate CPAP 1
• The European Respiratory Society has published guidelines on non-CPAP therapies for OSA, highlighting the importance of individualized treatment approaches 1

From the Research

CPAP Treatment for Asthma

• CPAP (Continuous Positive Airway Pressure) is typically used to treat obstructive sleep apnea, but research suggests it may also have a positive impact on asthma symptoms in patients with both conditions 2, 3.
• A study published in 2016 found that long-term CPAP treatment improved asthma control in patients with asthma and obstructive sleep apnea, with significant decreases in self-reported asthma severity and improvements in Asthma Control Test scores 2.
• Another study from 2008 reviewed the concept of a possible link between asthma and obstructive sleep apnea syndrome, and found that CPAP treatment had a positive impact on asthma outcome in patients with concomitant obstructive sleep apnea 3.

Mechanisms of CPAP Treatment for Asthma

• The mechanisms by which CPAP treatment improves asthma symptoms are not fully understood, but may include mechanical and neuromechanical effects, suppression of gastroesophageal acid reflux, and local and systemic anti-inflammatory effects 3.
• CPAP treatment may also improve cardiac function, reduce leptin levels, and promote weight reduction, all of which could contribute to improved asthma control 3.

Prehospital Use of CPAP for Asthma

• CPAP has been shown to alleviate symptoms and decrease the need for intubation in patients with acute respiratory distress, including those with asthma 4.
• Prehospital use of CPAP is safe, portable, and easy to apply, making it a useful tool for emergency medical services 4.

Relationship between Asthma and Sleep-Disordered Breathing

• There is a complex interaction between asthma and sleep-disordered breathing, with each condition affecting the severity of the other 5, 6.
• Inhaled corticosteroids, commonly used to treat asthma, may increase the risk of sleep apnea in a dose-dependent manner, particularly in adults 5.
• The severity of asthma is a key factor affecting the prevalence of sleep apnea in children, whereas inhaled corticosteroids appear to be a less significant risk factor 5.