TY - JOUR T1 - Noninvasive ventilation in severe life threatening asthma JF - European Respiratory Journal JO - Eur Respir J VL - 44 IS - Suppl 58 SP - P2084 AU - Yahya Abazed AU - Kerstin Krause AU - Gerhard Laier-Groeneveld AU - Husam Musleh Y1 - 2014/09/01 UR - http://erj.ersjournals.com/content/44/Suppl_58/P2084.abstract N2 - Patients with life threatening asthma suffer from episodic or long lasting overload of the respiratory muscles. In case of failure they require mechanical Ventilation (MV). If noninvasive ventilation is helpful in such disease is under debate.Methods: We report on two patients, who present severe airway obstructions and frequent life threatening asthma attacks. They were adapted to MV to use it daily and during their attacks. MV was set to completely unload the respiratory muscles to a degree that respiratory efforts were not necessary even during severe asthma attacks. They were trained over several weeks.Both patients had previously undergone multiple attempts to improve their asthma (high dose steroids, Xolair, Interferon, etc.) and been intubated several times. Daily corticoid dose ranged from 300 to 500mg (patient 1) and above 100mg (patient 2) together with high dose of ß agonists and inhaled corticosteroids.Results: To achieve a complete unloading during different levels of obstructions the volume preset mode was used with a tidal volume of 1.3l, PEEP=0, respiratory rate 20 and inspiration time of 1.2s resulting in a ventilation pressure exceeding 60mbar. Both patient´s diaries showed daily attacks and 3 to 6 life threatening events per month during which they effectively used MV. All attacks were managed at home and hospital stay decreased to 1 per year. The patients explain their experience and how to use MV in such critical situations.Conclusion: Passive noninvasive ventilation with high tidal volume and rapid inspiratory flow can unload the respiratory muscles even during most severe asthma attacks to avoid invasive ventilation. Intensive training to adapt to such ventilation is necessary. ER -