From the Guidelines
BiPAP (Bilevel Positive Airway Pressure) is not a recommended treatment for asthma management, as the current evidence primarily supports its use in obstructive sleep apnea (OSA) and other sleep-related breathing disorders 1.
Key Considerations
- The American Academy of Sleep Medicine clinical practice guideline suggests using CPAP or APAP over BPAP in the routine treatment of OSA in adults, with BPAP considered for patients with higher therapeutic pressure requirements or those who have previously failed CPAP or APAP 1.
- There is limited direct evidence on the use of BiPAP in asthma management, and the provided studies focus on its application in OSA and sleep-related breathing disorders 1.
- Asthma treatment typically involves bronchodilators, corticosteroids, and oxygen therapy, with positive airway pressure therapy not being a standard component of asthma management.
Clinical Decision-Making
- In cases of severe asthma exacerbations, the primary focus should be on optimizing conventional treatments, including bronchodilators and corticosteroids, rather than considering BiPAP as a primary intervention.
- If a patient with asthma also has a sleep-related breathing disorder, such as OSA, BiPAP may be considered as part of the treatment plan for the sleep disorder, but this should be guided by a sleep medicine specialist and based on individual patient needs 1.
Patient Care
- Close monitoring and adherence to standard asthma treatments are essential in managing asthma exacerbations, with BiPAP not being a recommended substitute for these treatments.
- Patients with severe asthma or those at risk of respiratory failure should be closely monitored, and alternative interventions, such as mechanical ventilation, should be considered if necessary.
From the Research
Role of BiPAP in Asthma Management
- BiPAP, or Bi-level Positive Airway Pressure, is a type of noninvasive ventilation that has been studied as a potential treatment for acute exacerbations of asthma 2, 3.
- The use of noninvasive respiratory supports, including BiPAP, may be beneficial in patients with severe asthma exacerbations who are at risk of developing acute respiratory failure 4.
- Noninvasive ventilation, including BiPAP, has been shown to provide airway stenting, optimal oxygen delivery, and decreased work of breathing, which may be beneficial for patients with acute exacerbations of asthma 2.
- However, the evidence surrounding the efficacy of BiPAP in asthma management is unclear, and larger, prospective randomized controlled trials are needed to determine its role in patients with asthma 3.
Key Findings
- A systematic review of 13 studies found a trend towards better outcomes for patients with acute asthma who were treated with noninvasive ventilation, including BiPAP, compared to standard medical therapy, but the variability of the studies meant that no conclusive recommendations could be made 2.
- A review of the use of noninvasive respiratory supports in the management of severe asthma exacerbations found that the application of these therapies is insufficiently supported by the evidence, and more research is needed to determine their potential benefits 4.
- A study on the management of life-threatening asthma found that noninvasive mechanical ventilation, including BiPAP, may be used to decrease the work of breathing and correct hypoxemia and hypercapnia, but endotracheal intubation and mechanical ventilation should not be delayed if clinical improvement is not achieved with conservative therapies 5.
Limitations of Current Evidence
- The current evidence on the use of BiPAP in asthma management is limited by the small number of studies and the variability of their designs, endpoints, and outcomes 2, 3.
- More research is needed to determine the efficacy and safety of BiPAP in patients with asthma, particularly in those with severe exacerbations 4, 3.