What is the role of Bi-level Positive Airway Pressure (BiPAP) therapy in managing asthma exacerbation?

From the Guidelines

BiPAP therapy is not recommended as a primary treatment for asthma exacerbation, and its use should be considered on a case-by-case basis for patients with severe respiratory distress who are not responding to standard treatments, as evidenced by studies such as 1 and 2. The primary treatment for asthma exacerbations, as outlined in the National Asthma Education and Prevention Program's Expert Panel Report 3 guidelines 3, consists of administration of oxygen, inhaled beta-2 agonists, and systemic corticosteroids. Some key points to consider when managing asthma exacerbations include:

• Assessing the severity of the exacerbation and monitoring the patient's response to treatment
• Using supplemental oxygen to correct significant hypoxemia
• Administering repetitive or continuous administration of short-acting beta-agonists (SABAs) to reverse airflow obstruction rapidly
• Administering oral systemic corticosteroids to decrease airway inflammation
• Monitoring response to therapy with serial assessments, including lung function measures and signs and symptoms scores, as described in 4. It is essential to note that BiPAP therapy may be beneficial in specific cases, such as when a patient shows signs of respiratory fatigue, has persistent hypoxemia despite supplemental oxygen, or demonstrates hypercapnia (elevated CO2 levels), but its use should be guided by the patient's individual needs and response to treatment. In general, the management of asthma exacerbations should focus on prompt initiation of standard treatments, close monitoring of the patient's response, and adjustment of therapy as needed to achieve optimal control of symptoms and prevention of future exacerbations, as recommended by 1 and 2.

From the Research

Role of BiPAP Therapy in Managing Asthma Exacerbation

• BiPAP (Bi-level Positive Airway Pressure) therapy is used as an adjunct treatment for severe asthma exacerbations, particularly in patients who do not respond to first-line treatments such as systemic corticosteroids and inhaled β-agonists 5.
• The use of BiPAP has been shown to improve respiratory distress in children with severe asthma exacerbation, with significant improvements in respiratory rate and oxygenation 6.
• Noninvasive ventilation, including BiPAP, has been suggested as a treatment for acute exacerbations of asthma due to its ability to provide airway stenting, optimal oxygen delivery, and decreased work of breathing 7.
• A systematic review of the literature found a trend towards better outcomes for patients with acute asthma who were treated with noninvasive ventilation, including BiPAP, compared to standard medical therapy, although more research is needed to make conclusive recommendations 7.
• The benefits of BiPAP therapy in managing asthma exacerbation include improved respiratory rate, oxygenation, and decreased work of breathing, with no significant increase in heart rate or additional irritation 6.

Comparison with Other Treatments

• BiPAP therapy has been compared to other treatments such as invasive mechanical ventilation, with some studies suggesting that hospitals that favor noninvasive mechanical ventilation, including BiPAP, have improved outcomes 5.
• The use of BiPAP has also been compared to other adjunct treatments such as heliox, inhaled steroids, and terbutaline, with varying degrees of success 5, 8.
• The choice of treatment for severe asthma exacerbation depends on various factors, including the severity of the exacerbation, the patient's response to first-line treatments, and the availability of resources 8, 9.

Clinical Applications

• BiPAP therapy can be used in various clinical settings, including emergency departments, intensive care units, and pediatric intensive care units 5, 8, 6.
• The use of BiPAP requires careful patient selection, monitoring, and adjustment of ventilator settings to ensure optimal outcomes 7, 6.
• Further research is needed to determine the optimal use of BiPAP therapy in managing asthma exacerbation, including the development of standardized protocols and guidelines 5, 7.