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AR Medford, JCT Pepperell
Journal Issue: 
Volume 36: Issue 1: 2006




We  describe  a  case  of  pneumothorax  occurring  in  an  asthmatic following NIV in a high dependency setting.  He had been persistently hypoxaemic related  to  bilateral  lower  lobe  collapse  from  extensive  mucus  plugging  with  no other secondary cause for his hypoxaemia or mucus plugging found.  There was no  obvious  evidence  of  initial  pneumothorax  and  we  presume  that  barotrauma related to NIV was responsible. We review the limited evidence for NIV in acute asthma and the recommendations from national guidelines. We conclude that NIV should only be considered in acute asthma in the context of a randomised controlled trial and applied only in a high dependency or intensive therapy  unit. Pneumothorax  must  be  excluded  in  asthmatics  that  deteriorate suddenly on NIV.