Noninvasive Ventilation for Severe Acute Asthmatic Attacks

Asthma is a chronic disease characterized by reversible airway obstruction caused by bronchial smooth muscle contraction, airway inflammation, and increased secretion. In most patients, control of disease activity is easily achieved with medical therapy. However, in a small minority, asthmatic attacks may be fatal. Some patients with severe asthmatic attacks are refractory to standard treatment, and a few of these patients have a history of severe asthmatic attacks that necessitated mechanical ventilation. In addition to the usual complications of mechanical ventilation, invasive mechanical ventilation in asthmatic patients is associated with other risks. These patients are often difficult to ventilate, have low compliance with high inspiratory pressures, and have frequent patient-ventilator asynchrony. Noninvasive ventilation (NIV) has been increasingly used to treat acute respiratory failure in the past two decades. It is now considered as standard first-line therapy in chronic obstructive pulmonary disease exacerbations and acute pulmonary edema. The increase in knowledge and experience has revived the use of NIV in asthma, which has previously been thought to be contraindicated. The purpose of this article is to review the up-to-date information on the use of NIV during severe acute asthmatic attacks. Nowadays, although sufficient data are not present to recommend the use of NIV in severe asthmatic attacks, there are some interesting and promising results about NIV. In conclusion, new well-designed studies including cases with respiratory acidosis and hypercapnia are necessary to eliminate the controversy.