Ventilation of patients with asthma and chronic obstructive pulmonary disease

Ventilatory intervention is often life-saving when patients with asthma or chronic obstructive pulmonary disease (COPD) experience acute respiratory compromise. Although both noninvasive and invasive ventilation methods may be viable initial choices, which is better depends upon the severity of illness, the rapidity of response, coexisting disease, and capacity of the medical environment. In addition, noninvasive ventilation often relieves dyspnea and hypoxemia in patients with stable severe COPD. On the basis of current evidence, the general principles of ventilatory management common to patients with acutely exacerbated asthma/COPD are these: noninvasive ventilation is suitable for a relatively simple condition, but invasive ventilation is usually required in patients with more complex or more severe disease. It is crucial to provide controlled hypoventilation, longer expiratory time, and titrated extrinsic positive end-expiratory pressure to avoid dynamic hyperinflation and its attendant consequences. Controlled sedation helps achieve synchrony of triggering, power, and breath timing between patient and ventilator. When feasible, noninvasive ventilation often facilitates the weaning of ventilator-dependent patients with COPD and shortens the patient's stay in the intensive care unit.