Nocturnal bilevel positive airway pressure for the treatment of asthma.

Nocturnal worsening of asthma may be due to reduced lung volumes and fewer sigh breaths, which have been shown to increase airway resistance and bronchoreactivity. We hypothesized that mimicking deep inspiration using nocturnal mechanical support would improve symptoms in patients with asthma. Subjects with asthma underwent usual care and bilevel positive airway pressure (PAP) therapy for 4 weeks, separated by 4 weeks, and methacholine challenge (PC ₂₀ ) and subjective assessments. 13 patients with asthma alone and 8 with asthma + OSA completed the protocol. Change in bronchoreactivity (ratio of Post/Pre PC ₂₀ ) was not significantly different during usual care and bilevel PAP [0.86 (IQR 0.19, 1.82) vs 0.94 (IQR 0.56, 2.5), p = 0.88], nor was the change in Asthma Control Test different: 0.1 ± 2.2 vs. -0.2 ± 2.9, p = 0.79, respectively. Bilevel PAP therapy for four weeks did not improve subjective or objective measures of asthma severity in patients with asthma or those with asthma and OSA, although there was heterogeneity in response.
Competing Interests: Declaration of Competing Interest RLO previously consulted for Philips Respironics. Philips Respironics provided the bilevel positive airway pressure machines and related equipment used in the study. As an Officer of the ATS, Dr. Malhotra relinquished all outside personal income in 2012. ResMed provided a philanthropic donation to UC San Diego for a Sleep Center. The other authors report no conflict of interest.
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