The current frequency of noninvasive (NIV) and invasive mechanical ventilation use in asthma exacerbations (AEs) and the relationship to outcomes are unknown.
METHODS:
We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample to identify patients discharged with a principal diagnosis of AE. For each discharge, we determined whether NIV or invasive mechanical ventilation was initiated during the first 2 hospital days. Using multivariate logistic regression to adjust for potential confounders, we determined whether use of mechanical ventilation and in-hospital mortality changed between 2000 and 2008.
RESULTS:
The number of AEs increased by 15.8% from 2000 to 2008. The proportion of admissions for which invasive mechanical ventilation was used during the first 2 days decreased from 1.4% in 2000 to 0.73% in 2008, whereas NIV use increased from 0.34% to 1.9%. The adjusted mortality from AEs requiring NIV or invasive mechanical ventilation was unchanged from 2000 to 2008. The hospital stay was also unchanged.
CONCLUSIONS:
There was a substantial increase in the use of mechanical ventilation, accompanied by a shift from invasive mechanical ventilation to NIV. Although we could not determine the clinical reasons for this increase, hospital stay and mortality were unchanged. A randomized trial is needed to determine whether NIV can improve outcomes in AEs before widespread adoption makes it impossible to conduct such a trial.
AkinbamiLJ, BaileyC, ZahranHS, KingM, JohnsonCA, LiuX. Trends in asthma prevalence, health care use, and mortality in the United States, 2001-2010. NCHS Data Brief, 2012;(94):1-8.
2.
GuptaD, KeoghB, ChungKF, AyresJG, HarrisonDA, GoldfradC, et al. Characteristics and outcome for admissions to adult, general critical care units with acute severe asthma: a secondary analysis of the ICNARC Case Mix Programme Database. Crit Care, 2004; 8(2):R112-R121.
3.
PendergraftTB, StanfordRH, BeasleyR, StempelDA, RobertsC, McLaughlinT. Rates and characteristics of intensive care unit admissions and intubations among asthma-related hospitalizations. Ann Allergy Asthma Immunol, 2004; 93(1):29-35.
4.
EisnerMD, BolandM, TolstykhI, MendozaG, IribarrenC. Intensive care unit admission for asthma: a marker for severe disease. J Asthma, 2005; 42(5):315-323.
5.
AfessaB, MoralesI, CuryJD. Clinical course and outcome of patients admitted to an ICU for status asthmaticus. Chest, 2001; 120(5):1616-1621.
6.
KrishnanV, DietteGB, RandCS, BilderbackAL, MerrimanB, HanselNN, KrishnanJA. Mortality in patients hospitalized for asthma exacerbations in the United States. Am J Respir Crit Care Med, 2006; 174(6):633-638.
7.
BramanSS, KaemmerlenJT. Intensive care of status asthmaticus. A 10-year experience. JAMA, 1990; 264(3):366-368.
8.
ShapiroJM. Intensive care management of status asthmaticus. Chest, 2001; 120(5):1439-1441.
9.
BurnsKE, AdhikariNK, KeenanSP, MeadeMO. Noninvasive positive pressure ventilation as a weaning strategy for intubated adults with respiratory failure. Cochrane Database Syst Rev, 2010(8):CD004127.
RamFS, PicotJ, LightowlerJ, WedzichaJA. Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev, 2004(3):CD004104.
12.
BrochardL, ManceboJ, WysockiM, LofasoF, ContiG, RaussA, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med, 1995; 333(13):817-822.
13.
GrayA, GoodacreS, NewbyDE, MassonM, SampsonF, NichollJ. Noninvasive ventilation in acute cardiogenic pulmonary edema. N Engl J Med, 2008; 359(2):142-151.
14.
RoccoM, Dell'UtriD, MorelliA, SpadettaG, ContiG, AntonelliM, PietropaoliP. Noninvasive ventilation by helmet or face mask in immunocompromised patients: a case-control study. Chest, 2004; 126(5):1508-1515.
15.
RamFS, WellingtonS, RoweBH, WedzichaJA. Non-invasive positive pressure ventilation for treatment of respiratory failure due to severe acute exacerbations of asthma. Cochrane Database Syst Rev, 2005(1):CD004360.
16.
MeduriGU, CookTR, TurnerRE, CohenM, LeeperKV. Noninvasive positive pressure ventilation in status asthmaticus. Chest, 1996; 110(3):767-774.
17.
SorokskyA, StavD, ShpirerI. A pilot prospective, randomized, placebo-controlled trial of bilevel positive airway pressure in acute asthmatic attack. Chest, 2003; 123(4):1018-1025.
18.
FernándezMM, VillagráA, BlanchL, FernándezR. Non-invasive mechanical ventilation in status asthmaticus. Intensive Care Med, 2001; 27(3):486-492.
19.
SomaT, HinoM, KidaK, KudohS. A prospective and randomized study for improvement of acute asthma by non-invasive positive pressure ventilation (NPPV). Intern Med, 2008; 47(6):493-501.
MartinGS, ManninoDM, EatonS, MossM. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med, 2003; 348(16):1546-1554.
22.
CamargoCAJr, WeissST, ZhangS, WillettWC, SpeizerFE. Prospective study of body mass index, weight change, and risk of adult-onset asthma in women. Arch Intern Med, 1999; 159(21):2582-2588.
23.
DeyoRA, CherkinDC, CiolMA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol, 1992; 45(6):613-619.
24.
GuptaD, NathA, AgarwalR, BeheraD. A prospective randomized controlled trial on the efficacy of noninvasive ventilation in severe acute asthma. Respir Care, 2010; 55(5):536-543.
25.
McFaddenERJr, WarrenEL. Observations on asthma mortality. Ann Intern Med, 1997; 127(2):142-147.
26.
GetahunD, DemissieK, RhoadsGG. Recent trends in asthma hospitalization and mortality in the United States. J Asthma, 2005; 42(5):373-378.
27.
BarnesPJ. Severe asthma: advances in current management and future therapy. J Allergy Clin Immunol, 2012; 129(1):48-59.
HartertTV, TogiasA, MellenBG, MitchelEF, SnowdenMS, GriffinMR. Underutilization of controller and rescue medications among older adults with asthma requiring hospital care. J Am Geriatr Soc, 2000; 48(6):651-657.
30.
JohnsonKB, BlaisdellCJ, WalkerA, EgglestonP. Effectiveness of a clinical pathway for inpatient asthma management. Pediatrics, 2000; 106(5):1006-1012.
31.
MayoPH, WeinbergBJ, KramerB, RichmanJ, Seibert-ChoiOS, RosenMJ. Results of a program to improve the process of inpatient care of adult asthmatics. Chest, 1996; 110(1):48-52.
32.
EvansR3rd, LeBaillyS, GordonKK, SawyerA, ChristoffelKK, PearceB. Restructuring asthma care in a hospital setting to improve outcomes. Chest, 1999; 116(4 Suppl 1):210S-216S.
33.
SawickiGS, VilkY, SchatzM, KleinmanK, AbramsA, MaddenJ. Uncontrolled asthma in a commercially insured population from 2002 to 2007: trends, predictors, and costs. J Asthma, 2010; 47(5):574-580.
34.
FarahCS, KermodeJA, DownieSR, BrownNJ, HardakerKM, BerendN, et al. Obesity is a determinant of asthma control independent of inflammation and lung mechanics. Chest, 2011; 140(3):659-666.
35.
QuanH, ParsonsGA, GhaliWA. Validity of procedure codes in International Classification of Diseases, 9th revision, clinical modification administrative data. Med Care, 2004; 42(8):801-809.
36.
EstebanA, Frutos-VivarF, FergusonND, ArabiY, ApezteguíaC, GonzálezM, et al. Noninvasive positive-pressure ventilation for respiratory failure after extubation. N Engl J Med, 2004; 350(24):2452-2460.
