Are BiPAP Machines Safe for Asthma Treatment?

If you have a severe asthma attack that requires you to be hospitalized, doctors in the Intensive Care Unit (ICU) may use a machine to help you breathe. For some people, that may be a BiPAP machine.

What is a BiPAP machine?

BiPAP stands for short for bilevel positive airway pressure. It is a form of mechanical ventilation that uses air pressure to push air into your lungs. You wear a mask or nasal plugs that are connected to the machine. A BiPAP machine delivers higher pressure air when you breathe in (inhale) and lower pressure air when you breathe out (exhale).¹

You may use a BiPAP machine at home for sleep apnea. With sleep apnea, breathing is interrupted for short periods while a person sleeps. These periods last for at least 10 seconds. BiPAP machines may also be used to treat other conditions, such as:¹

• Chronic obstructive pulmonary disorder (COPD)
• Obesity hypoventilation syndrome
• Pneumonia
• Poor breathing after an operation
• A neurological disease that disturbs breathing

When is BiPAP used for asthma treatment?

Asthma affects about 5.5 million children and 19.2 million adults in the United States. Severe asthma attacks cause about 1.6 million emergency department visits each year.²

For severe acute asthma or asthma that does not respond to usual medicines, treatment includes additional medicines and mechanical ventilation to support your breathing.³

Doctors use mechanical ventilation for several reasons, including when people have:⁴

• Pronounced increase in difficulty breathing
• A buildup of carbon dioxide in your blood (hypercapnia)
• Below-normal level of oxygen in your blood (hypoxemia)

There are 2 types of mechanical ventilation:^3,5

• Invasive ventilation – When a tube is inserted into your throat to serve as an artificial airway. It is linked with a longer ICU stay and higher rates of pneumonia and death in the hospital.
• Noninvasive ventilation – This method avoids having a tube inserted into your throat. BiPAP is the most common noninvasive ventilation. BiPAP machines reduce how hard your breathing muscles need to work. This increases oxygen levels and relieves breathing distress.

Who does it help?

Studies show that noninvasive ventilation, like BiPAP, helps both adults and children with severe asthma attacks.

One 2020 study found that adults with acute asthma in the ICU who received noninvasive ventilation before invasive ventilation fared better while in the hospital.⁶

Another 2020 study found that BiPAP improved the breathing rate and oxygen levels in children with severe asthma attacks. Their carbon dioxide levels decreased, while their heart rate did not increase. This suggests that BiPAP may help children who need help with breathing but are uncomfortable with a breathing tube.^1,4

Noninvasive ventilation, including BiPAP, is not recommended for people with:^1,4,8

• Reduced or loss of consciousness
• Problems swallowing
• Loss of gag reflex
• Respiratory arrest (when you stop breathing
• Cardiac arrest (when your heart stops pumping blood)

What are the risks of using BiPAP?

BiPAP has a lower risk of serious complications, such as infections, than invasive ventilator support. However, BiPAP risks include:¹

• Skin damage from the mask
• Mild stomach bloating
• Dry mouth
• Lower air pressure than intended because of leaks from the mask
• Eye irritation
• Sinus pain or congestion

Eating or drinking while using BiPAP may cause you to inhale food or liquid into your lungs.¹

It is important to note that some people using BiPAP may have to switch to invasive ventilation while in the hospital. However, data does not clearly show whether noninvasive ventilation reduces either the need for invasive ventilation or rates of death in the hospital.¹⁰

Is BiPAP recommended for people with asthma?

Over the past 20 years, noninvasive ventilation, including BiPAP, has been used more and more for acute asthma attacks. However, there have not been many large randomized controlled clinical trials to study this method. These types of trials are considered the gold standard for medical research.¹¹

Many doctors and researchers have different opinions on using BiPAP for acute asthma attacks:^3,12,13

• The European Respiratory Society/American Thoracic Society does not recommend for or against the use of noninvasive ventilation in acute asthma
• The National Asthma Education and Prevention Program considers the use of BiPAP for asthma to be experimental
• The 2020 Global Initiative for Asthma recommends close monitoring of people using noninvasive ventilation for acute asthma attacks

More high-quality research is needed to examine the effects of BiPAP in acute asthma attacks. If you have questions about how BiPAP may impact your asthma care, talk to your doctor.

Have you used a BiPaP during emergency asthma care? Share your experience in the comments below.