Noninvasive ventilation in severe acute asthma? Still far from the truth.

Despite the continuous improvement in the therapeutic strategy for asthma, there is still a subset of asthma exacerbations—severe acute asthma—that still requires access to the emergency department and, eventually, hospitalization.1-3 It’s estimated that approximately 5–10% of asthmatic patients experience a severe acute asthma episode in a given year, and that there are approximately 2 million emergency department visits and 500,000 hospital admissions yearly, which leads to a corresponding consumption of health-care resources.4 Furthermore, even with the implementation of the optimized standard medical treatment (ie, medical and oxygen therapy), approximately 10% of individuals admitted to the hospital for severe acute asthma still go to the intensive care unit (ICU).5 On the other hand, it’s estimated that approximately 2–20% of medical ICU admissions are attributed to severe acute asthma.6,7 Therefore, endotracheal intubation and conventional mechanical ventilation are deemed necessary in up to one third of the severe-acute-asthma patients admitted to the ICU (approximately 2–20 patients per year). Mortality as high as 27% has been reported in invasively ventilated patients,6,8 given the likelihood of life-threatening intubation-associated complications in severe acute asthma (eg, barotrauma, cardiovascular collapse, cardiac arrhythmia, acute coronary syndromes, atelectasis, and pneumonia).3,9,10