Asthma remains a common respiratory disorder, and despite advances in its outpatient management, patients continue to present to the emergency room department as a result of an acute exacerbation. While the vast majority of cases are managed with inhaled bronchodilators and systemic steroids, some patients present with severe respiratory distress and require ventilatory support. Traditionally, the only option beyond medical therapy has been endotracheal intubation and conventional mechanical ventilation. However, care becomes more complicated after intubating a patient with severe asthma due to the potential for severe dynamic hyperinflation and cardiovascular collapse. While it is not the purpose of this chapter to discuss the approach to invasive mechanical ventilation of the asthmatic patient, it is sufficient to say that great care and attention are required by those skilled in these areas, and even this does not preclude significant morbidity. The use of noninvasive ventilation (NIV) for patients with severe acute exacerbations of chronic obstructive pulmonary disease (COPD) associated with respiratory failure has become increasingly recognized as first-line therapy after usual medical therapy and oxygen [1, 2]. The evidence supporting the use of NIV in acute exacerbations of asthma is more limited. The objective of this chapter is to provide a review of the current literature and summary recommendations for the use of NIV in this setting.
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