A new systematic review is reigniting interest in the use of noninvasive ventilation (NIV) for adults experiencing acute asthma exacerbations, suggesting it may significantly reduce the need for intubation and hospital admissions.
The review, “Noninvasive Ventilation in Acute Asthma Exacerbations: A Systematic Review,” was recently published in Annals of the American Thoracic Society. Its authors concluded that adding NIV to standard medical therapy was not only associated with a reduced risk of intubation, but it also accelerated clinical improvement in patients struggling with severe asthma attacks.
Researchers analyzed data from eight randomized controlled trials (RCTs) and five observational studies comparing NIV plus standard medical therapy to standard therapy alone. In the RCTs, patients receiving NIV experienced a 54% reduction in intubation rates, while patients from observational studies had a 45% reduction. Combined, hospital admission rates dropped by 43%. Additionally, the time to improvement in accessory muscle use was shortened by more than an hour. Other outcomes, such as dyspnea and lung function, also benefitted from NIV but did not reach statistical significance.
Despite the promising results, the study’s authors cautioned that the overall quality of evidence remains low to very low, largely due to small sample sizes and variability in study design. Mortality outcomes could not be reliably assessed due to the low number of deaths reported.
Still, the findings could have important clinical implications. The observed reduction in intubation could be lifesaving, underscoring the fact that intubation in asthma patients is often linked to higher mortality. The authors suggested NIV could be considered as an adjunct to standard therapy in acute asthma management.
The study called for updated clinical guidelines and additional high-quality trials to confirm the benefits of NIV in this setting. Its authors also suggested that a trial of NIV may be warranted in adults with acute asthma exacerbations who do not respond adequately to standard therapy.
