NON-INVASIVE POSITIVE PRESSURE VENTILATION FOR MANAGEMENT OF PATIENTS WITH MODERATE TO SEVERE ACUTE EXACERBATION OF ASTHMA
ATEFEH FAKHARIAN
Chronic Respiratory Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
MASOUMEH HOSEINI ASKARABADI *
Chronic Respiratory Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran and Masih Daneshvari Hospital, Darabad Ave., Tehran, Iran
*Author to whom correspondence should be addressed.
Abstract
Background and Objectives: Noninvasive ventilation (NIV) is increasingly used for management of acute asthma attacks but evidence supporting its optimal efficacy is scarce. This study aimed to assess the efficacy of noninvasive positive-pressure ventilation (NIPPV) in patients presenting with moderate to severe acute asthma attacks.
Materials and Methods: Thirty-four patients presenting to the emergency room of Masih Daneshvari Hospital due to asthma attack with confirmed diagnosis of asthma were randomly divided into two groups (n=17) and subjected to baseline assessments including physical examination, assessment of dyspnea by Borgscale, arterial blood gas analysis, spirometry, electrocardiography and chest X ray. After standard treatment, according to the global initiative for asthma (GINA) protocol, group 1 received NIPPV using bilevel positive airway pressure (BIPAP) for 120 minutes with inspiratory positive airway pressure (IPAP) of 12 cmH2O and expiratory positive airway pressure (EPAP) of 4 cmH2O via a facemask. Group 2 (sham) received a face mask without pressure for 120 minutes while the BIPAP was off. The afore-mentioned assessments were repeated at 1, 3, 8 and 24 hours after treatment. The results were compared between the two groups.
Results: Patients in both groups showed significant changes in heart rate, oxygen saturation rate, peak expiratory flow, forced vital capacity (FVC) and degree of dyspnea after treatment (P<0.05). In the control (sham) group, significant change also occurred in respiratory rate (P<0.05). The difference between NIPPV and sham group after treatment was significant in some parameters (P<0.05): FVC was 47% and 42% at one hour (P=0.02) and 53% and 44% at three hours (P=0.006) post-treatment in NIPPV and sham groups, respectively. FEV1/FVC predicated was 77% and 66% in NIPPV and sham groups, respectively at eight hours post-treatment (P=0.02). The arterial pH was 7.43 and 7.40 at one hour post-treatment (P=0.01). The NIPPV group showed significantly lower degree of dyspnea post-treatment compared to the sham group (P=0.01).
Conclusion: Patients who received NIV in addition to standard medical therapy for management of acute asthma exacerbation showed greater improvement in their degree of dyspnea and pulmonary function tests.
Keywords: Asthma, noninvasive ventilation, disease management