Use of noninvasive ventilation in adult patients with acute asthma exacerbation

Noninvasive ventilation (NIV) has been found to be beneficial for respiratory failure in many disease states; however, limited data are available supporting its use in acute asthma exacerbation. A retrospective chart analysis of adult patients admitted for acute asthma exacerbation and treated with NIV between January 2007 and December 2009 at a tertiary care community hospital was done. Ninety-eight patient encounters were identified. Mean age of the patients was 48.3 years, and 46% were male. Nineteen patients failed NIV and required invasive ventilation. There was no significant difference in the mean age, sex, race, and initial blood gas between patients with successful versus failed NIV. Usage of drugs, smoking, and history of past hospital or intensive care unit admission or intubation did not significantly influence the rate of failure of NIV. Patients who needed higher initial FiO2 were more likely to get intubated during their hospital stay (46.2 vs. 20.4%, P = 0.019). Patients who failed NIV were found to have longer duration of hospital stay (6.8 vs. 3.9 days, P= 0.016) and longer intensive care unit stay (4 vs. 0.9 days, P = 0.002). Use of inhalers and other medications was not found to significantly influence the rate of failure of NIV. NIV can be used initially in patients with acute asthma exacerbation, as it is associated with shorter duration of hospital stay and can prevent the morbidity of mechanical intubation. Patients with initial requirement of higher FiO2 were more likely to fail NIV and should be carefully monitored.