Continuous Positive Airway Pressure (CPAP) Improves Pulmonary Function in Pediatric Acute Asthma

Objectives: Although noninvasive ventilation has shown promise in acute obstructive lung disease, use of continuous positive airway pressure (CPAP) in pediatric asthma has not been examined prospectively. This study assessed the efficacy of CPAP in acute pediatric asthma exacerbations. Methods: Prospective, randomized, controlled trial at an urban emergency department (ED). A convenience sample of patients age 8 to 21 was enrolled. Peak expiratory flow (PF), Borg scale of dyspnea, and other vital signs were recorded. All patients received oral steroids and nebulized albuterol and ipratropium. The control group received nebulizers via standard facemask, and the CPAP group used the Boussignac mask (an open, positive pressure ventilatory valve) with in-line nebulization, at a pressure of 5cm H2O. Vital signs were recorded at the start of treatment and at the end of the one-hour study period. Changes in PF (percent of predicted based on age and height), Borg score change, length of stay in the ED, and final disposition were compared using the t-test. Results: 41 patients were randomized to the CPAP group and 42 to the control. Mean age for the entire sample was 15.1 years (standard deviation [SD] 4.3), 60% were female, 45% Hispanic, 50% Black, and 5% other. At baseline, there were no significant differences between the control and the CPAP groups in age, height, blood pressure, pulse, respiratory rate, oxygen saturation, PF (mean 0.71 of predicted, SD 0.29) or Borg score (mean 4.96, SD 2.52). After treatment, there was a greater improvement in PF as percent predicted for the CPAP group compared to the control (0.23 [SD 0.15] vs. 0.1 [SD 0.15]; p=<0.0001). There were no differences in rate of discharge, hospital admission, number returning to the ED, or ED length of stay. Conclusions: CPAP is safe, and appears to improve initial ED treatment of pediatric acute asthma. This has not been previously studied in a randomized, prospective fashion.