Non-invasive ventilation in severe asthma attacks

Non-invasive ventilation (NIV) is a very effective technique for severe acute exacerbations of COPD/COLD and acute pulmonary edema, but its interest is still a matter of debate for severe asthma attacks. However, despite a slow decrease in asthma mortality, which actually mainly concerns older people, the prevalence of asthma is still raising and is associated to a high level of emergency visits and ICU hospitalizations for severe asthma attacks. Unfortunately, the level of knowledge on this topic is based only on observational studies and on 4 small RCTs, likely to be underpowered to demonstrate any benefit on the rate of tracheal intubation or on mortality. Nevertheless, some benefits have been shown with regard to functional improvement and length of hospital stay. From a technical point of view, one can expect in the future some improvements by combining NIV and nebulization and/or helium-oxygen therapy. Finally, there is a need for positive large randomized clinical trials before routine clinical use can be firmly recommended.