Pneumothorax following non-invasive ventilation for acute asthma

Abstract

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.

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