Non-invasive positive pressure ventilation for treatment of respiratory failure due to severe acute exacerbations of asthma

Ram FSF, Wellington SR, Rowe BH, Wedzicha JA

Published Online:

October 7, 2009

Non-invasive positive pressure ventilation (NPPV) enhances breathing in acute respiratory conditions by resting fatigued breathing muscles. It has the advantage that it can be applied intermittently for short periods, which may be sufficient to reverse the breathing problems experienced by patients during severe acute asthma. This review was undertaken to determine the effectiveness of NPPV in patients with severe acute asthma. Only one trial could be included in the review; however, compared to usual medical care alone NPPV reduced hospitalisations, increased the number of patients discharged from the emergency department, and improved respiratory rate and lung function measurements. The application of NPPV in patients suffering from status asthmaticus, despite some promising preliminary results, still remains controversial. Further studies are needed to determine the role of NPPV in the management of severe acute asthma.

Abstract (click to read)

Background:

Non-invasive positive pressure ventilation (NPPV) has been shown to be effective in chronic obstructive pulmonary disease patients with acute respiratory failure. However, its role in patients with severe acute asthma is uncertain. The pathophysiologic condition of acute respiratory failure in asthma is in many ways similar to that of acute respiratory failure in COPD. Therefore, there is reason to believe that NPPV could also be successful in patients with severe acute asthma.

Objectives:

To determine the efficacy of NPPV in adults with severe acute asthma in comparison to usual medical care with respect to mortality, tracheal intubation, changes in blood gases and hospital length of stay.

Search strategy:

An initial search for studies was carried out using CENTRAL. Additional searches were also carried out on MEDLINE, EMBASE, CINAHL, Science Citation, web based clinical trials databases and key journals with web sites were also searched as well as respiratory conference proceedings. Following this, the bibliographies of each randomised controlled trial obtained (and any review articles) was searched for additional studies (May 2005).

Selection criteria:

Only RCTs in adults patients with severe acute asthma were considered for inclusion. Studies including patients with features of COPD were excluded unless data was provided separately for patients with asthma in studies recruiting both COPD and asthma patients.

Data collection and analysis:

All data was analysed using RevMan. For continuous variables, a weighted mean difference and 95% confidence interval (95%CI) was calculated for each study outcome. For dichotomous variables relative risk with 95% confidence interval was calculated.

Main results:

From an initial search of 696 abstracts, 11 trials were obtained in full-text for closer examination. Ten trials were excluded and one included. The one included trial, on 30 patients, showed benefit with NPPV when compared to usual medical care alone with significant improvements in hospitalisation rate, number of patients discharged from emergency department, percent predicted FEV1, FVC, PEFR and respiratory rate.

Authors' conclusions:

The application of NPPV in patients suffering from status asthmaticus, despite some interesting and very promising preliminary results, still remains controversial. Large, prospective, randomised controlled trials are therefore needed to determine the role of NPPV in status asthmaticus.

This record should be cited as:

Ram FSF, Wellington SR, Rowe BH, Wedzicha JA. Non-invasive positive pressure ventilation for treatment of respiratory failure due to severe acute exacerbations of asthma. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD004360. DOI: 10.1002/14651858.CD004360.pub3

Assessed as up to date:

May 10, 2005

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Primary Review Group:

Airways Group

Health topics:

Lungs & airways > Asthma (acute) > Ventilation & oxygen

Anaesthesia & pain control > Ventilation in peri-anaesthetic/critical care

Lungs & airways > Ventilation in peri-anaesthetic/critical care

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Non-invasive positive pressure ventilation for treatment of respiratory failure due to severe acute exacerbations of asthma

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