Corresponding author: Patricia Jabre, (Samu de Paris, AP-HP, Necker-Enfants Malades Hospital, Paris, France) — patricia.jabre@aphp.fr
Submitted: 24 Feb 2026 · Accepted: 1 March 2026
Asthma is the most common chronic disease in children and accounts for 2.3% of pediatric hospitalizations. This condition has a major medico-economic impact, affecting both children’s quality of life and healthcare costs. In 10–12% of cases, intensive conventional treatment based on bronchodilators and corticosteroids is insufficient, and management must be escalated to endotracheal intubation and invasive mechanical ventilation. Some observational studies suggest that non-invasive positive pressure ventilation (NPPV) could reduce the need for intubation.
To assess the effects of NPPV combined with conventional treatments compared with conventional treatments alone in children with moderate to severe acute asthma, in terms of mortality, occurrence of serious adverse events (SAEs), length of stay in intensive care, and asthma symptom scores during the acute phase.
No all-cause mortality was reported in either group. Only one randomized study assessed SAEs, namely the intubation rate. Bilevel positive airway pressure (BiPAP) may substantially reduce the intubation rate and appears to shorten the length of stay in intensive care, but these results are very uncertain (very low level of evidence). Acute asthma symptoms score was evaluated in only two studies using different outcome measures, which did not allow meta-analysis. BiPAP may have a beneficial effect on the score, but this result is also very uncertain (very low level of evidence).
Current data are limited, with small sample sizes, resulting in very uncertain evidence and preventing a comprehensive evaluation of the benefits and risks of NPPV in children with acute asthma. Large, well-designed randomized controlled trials with low risk of bias are therefore needed.
In the trials included in the review, the positive end-expiratory pressure (PEEP) was relatively low (4–5 cmH₂O), whereas pressures of 8 to 12 cmH₂O may be necessary to compensate for intrinsic PEEP.
1. Urgence SMUR, Brest, France
2. Université de Franche-Comté, CHU Besançon, Urgences – SAMU, Besançon, France
3. Samu de Paris, AP-HP, Necker-Enfants Malades Hospital, Paris, France
All authors contributed equally and validated the final version of record.
This editorial is a summary of a systematic review previously published in the Cochrane Database of Systematic Reviews (see https://www.cochranelibrary.com/ for more information). This summary is prepared in coordination with Patricia Jabre, Daniel Meyran, Julie Dumouchel, Yannick Auffret, Nordine Nekhili, Nicolas Cazes, Aurélien Renard et Tania Marx from the Cochrane Pre-hospital and Emergency Care Group.
The Authors declare that there is no conflict of interest.
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
No registration applicable.
No new data were created or analyzed in this study. Data sharing is not applicable to this article.
Ethical approval for this study was not required.