Does non-invasive ventilation improve patient outcome or relive symptoms in acute asthma attacks

Date First Published:
April 4, 2016
Last Updated:
May 25, 2016
Report by:
David Jeffrey, Resuscitation officer (GG&C)
Search checked by:
David Jeffrey, GG&C
Three-Part Question:
in [patients with acute asthma] does [Non invasive ventilation] improve [outcome, ITU admission, need for invasive ventilation]
Clinical Scenario:
in patients wirh acute severe asthma, does NIV improve outcome?
Search Strategy:
Cinahl, medline, embase database searches
Search Details:
Key words used asthma, NIV, Non-invasive ventilation. searches comined using and/ or selection limited to English, Adult, human.
Outcome:
74 articles in initial results.
duplicates removed. Titles read and then abstracts from relevent titles.
4 RCTs identified for review.
Relevant Paper(s):
Study Title Patient Group Study type (level of evidence) Outcomes Key results Study Weaknesses
Reversal of bronchial obstruction with bi-level positive airway pressure and nebulization in patients with acute asthma Brandao et al 2009 Brazil Adults aged 18-65 admitted with acute severe asthma Randomised control trial Intervention group showed an increase in PEF FCV AND FEV when compared with the control group
A prospective randomised control trial on the efficacy of noninvasive ventilation in severe acute asthma Gupta et al 2010 India Adults with acute severe asthma Rct patients with acute severe asthma attending a&e after diagnosis were randomised into control where standard medical treatment was given and intervention, standard medical treatment + NIV NIV arm had shorter LOS IN ICU, Mean dose of inhaled bronchodilator was less Small RCT. 53 included in trial
A prospective and randomised study for improvement of acute asthma by non-invasive positive pressure ventilation. (NIPPV) Soma et al 2008 Japan Patients with acute asthma with mild or moderate severity RCT standard medical therapy( control)14 high pressure NIV intervention group 14and low pressure intervention group. 12 Nippv(h)FEV1 significantly improved in intervention group Nippv(h) significant improvement in modified Borg scale acore Small study 12-14 in each group
A pilot prospective randomised placebo-controlled trial of bi level positive airway pressure in acute asthma attack Soroksky et al 2003 Finland Adults with acute severe asthma RCT. Blinded. Conventional medical treatment in + sham ventilation. (Control) standard conventional medical treatment + NIV in intervention FEV pefr FCV significantly better than control arm Respiratory rate less in I tervention Small trial. No mention of how randomisation was carried out.
Author Commentary:
No statistically significant differences found between groups in PEF or spirometry however the intervention group had a shorter ICU stay and reduced LOS in hospital.
Bottom Line:
NIV could reduce LOS IN ICU and hospital in patients with acute severe asthma
References:
  1. Brandao et al. Reversal of bronchial obstruction with bi-level positive airway pressure and nebulization in patients with acute asthma
  2. Gupta et al. A prospective randomised control trial on the efficacy of noninvasive ventilation in severe acute asthma
  3. Soma et al. A prospective and randomised study for improvement of acute asthma by non-invasive positive pressure ventilation. (NIPPV)
  4. Soroksky et al. A pilot prospective randomised placebo-controlled trial of bi level positive airway pressure in acute asthma attack