The Successful Use of Noninvasive Ventilation in Severe Asthma Exacerbation: A Case Report and Review of the Literature

Acute exacerbations of bronchial asthma (AEBA) complicated by hypercapnic respiratory failure (RF) are traditionally managed with invasive mechanical ventilation (IMV) when medical therapy fails. However, IMV is associated with significant complications, including barotrauma, hemodynamic instability, and increased mortality. The role of noninvasive ventilation (NIV) in AEBA remains controversial due to the limited and inconsistent nature of the available evidence. We report the case of an 18-year-old female with a history of bronchial asthma who presented with severe AEBA and acute hypercapnic RF that was refractory to standard medical therapy, including bronchodilators, systemic corticosteroids, epinephrine, and magnesium sulfate. Arterial blood gas (ABG) analysis demonstrated respiratory acidosis, with a peak partial pressure of carbon dioxide (PaCO2) of 58 mmHg and a pH of 7.21. Although she was markedly tachypneic and in significant respiratory distress, she remained alert and hemodynamically stable, which allowed for a closely monitored trial of bilevel positive airway pressure (BiPAP) in the ICU. Rapid improvement in gas exchange was observed within three hours, with complete normalization by 10 hours, thereby avoiding the need for endotracheal intubation.