A prospective and randomized study for improvement of acute asthma by non-invasive positive pressure ventilation (NPPV)

Objective We hypothesized that non-invasive positive pressure ventilation (NPPV) would improve an acute asthma attack in mild to moderate cases without bronchodilator therapy. Methodology A total of 44 eligible patients with acute asthma of mild to moderate severity who had acute attacks were randomly allocated to a NPPV (n=30) or control group (n=14). Both groups received intravenous infusion of hydrocortisone prior to the study. Patients in the NPPV group were divided into two subgroups at random: a high- (n=16) and a low-pressure group (n=14). The former had a fixed expiratory positive airway pressure and inspiratory positive airway pressure of 6 cmH(2)O and 8 cmH(2)O, respectively, while the latter had levels of 4 cmH(2)O and 6 cmH(2)O, respectively. Effects on the following variables were assessed: FEV1, oxygen saturation, heart rate, respiratory rate, scores of accessory muscle use and wheezing by auscultation, modified Borg scale score, and mean intra-airway pressure on the monitor. Results A total of 26 patients completed the study in the NPPV group. The mean percent change in FEV1 significantly improved after 40 minutes in the high- pressure group compared with that in the control group (p<0.0001). Similar significant improvements in modified Borg scale score and physical examination findings were observed in the high- and low-pressure groups. None of the patients required re-hospitalization or return to the emergency room in either the NPPV or control group. Conclusion We conclude that higher inflation pressure on NPPV led to clinical improvement in patients with acute asthma attacks of mild to moderate severity.