An Updated Review on the Use of Noninvasive Respiratory Supports in the Management of Severe Asthma Exacerbations

Abstract

Asthma is a reversible clinical condition characterized by airway obstruction due to bronchial smooth muscle contraction, inflammation and a hypersecretive state. Severe asthma exacerbations (SAE) may be a part of the natural history of this condition. Patients presenting with SAE are at higher risk of recurrent attacks, often nonresponsive to medical therapy and eventually requiring invasive mechanical ventilation (MV). The use of noninvasive respiratory supports (NRSs) may be beneficial in patients with SAE who are at risk of developing acute respiratory failure (ARF). However, their application is insufficiently supported by the evidence, as reports on their application in asthmatic patients are scarce and only a few retrospective studies with a limited number of participants have been published to date. This review discusses the potentialities of NRS in the treatment of SAE, with reference to the pathophysiological background and future perspectives on their use in asthma management.

Keywords: ARF; CPAP; HFNOT; NIV; NPPV; acute respiratory failure; asthma; high flow nasal cannula; mechanical ventilation; noninvasive intermittent positive pressure ventilation; noninvasive ventilation; status asthmaticus.

Figure 1

Infographic on NRS-suggested initial settings for the treatment of acute asthma exacerbations (IPAP: inspiratory positive airway pressure; EPAP: expiratory positive airway pressure, VAS: visual analogue scale) [8].