| BackgroundThe outbreak of asthma is affected by both genetic factor and environment factor. In recent years, accompany with improving of living environment of human being, morbility and mortality of asthma raises year by year. It is estimitated that there are 300 million persons affected by asthma with the morbility of it from 1% to 5%, so the World Health Organization defines asthma as a disease for lifelong treatment. At present, the main treament of asthma is still the use of glucocorticosteroid, trachea diastolics, antibiotics, and so on. After the treatment above, the marjority of patients can relieve, while the therapeutic effect of a partial patients is not good, requiring tracheal intubation or incision of trachea to construct artificial airway, which will produce great sufferring, result in severe complications, cause or aggravate pulmonary infection, in addition of formidable reception of patients with consciousness. And severe asthma has airway hyperreactivity, so it is difficult to use IPPV because of airway spasm. Recently, non-invasive positive pressure ventilation has been extensively applicated in treatment of moderate and severe asthma. It can less the complications of tracheal intubation and ventilator, especially the occurrence of ventilator associated pneumonia. Among non-invasive positive pressure ventilation, Bilevel positive airway pressure is a frequently used type. The level of PaO2 and SaO2 obviously rises, and the level of PaCO2 markedly decreases, after treatment by combination applying of conventional therapy and BiPAP. In 1990, it was successfully used in treatment of obstrctive sleep apnea syndrome, soon after, many patterns of Bilevel positive airway pressure ventilators with certain efficacy, safety, compliance have been upgraded. Currently, it has been extensively applicated in treatment of asthma, and people pay more attention to the effectiveness , mechanism and clinic value gradually.objectiveTo assess the clinic value of bilevel positive airway pressure in the treament of moderate and severe asthma.Methods80 cases with moderate and severe asthma admited to the First Hospital of Jilin University were included and assigned into two groups randomly: control group only with conventional therapy, such as oxygen inhalation, trachea diastolics, antibiotics and so on, observation group with both BiPAP (S/T mode, IPAP 16-20cmH2O, EPAP 3-5cmH2O, 3-4 hours once, twice or three times one day) and conventional therapy. All lasted for 3 days, he score of symtom, the parameters of vital signs(Heart Rate, Respiratory Rate, Mean arterial Pressure), artery blood gas analysis (pH, PaO2, PaCO2, SaO2), pulmonary ventilation function test (FEV1, FEV1/FVC, PEF) between the two groups were compared, before 1 day and the third day after therapy. Otherwise, the ratio of hospital discharge, tracheal intubation, fatality and mean days of hospitalization between the two groups were compared.Results1. The improvement of symptom of observation group was better than control group, and the scores of symtom between the two groups had statistical significance (P <0.05). 2. After 3 days therapy, the improvement of vital sign was better than before: the difference of decrease of HR, RR and MAP had statistical significance (P <0.05); The difference of decrease of them between the two groups after treatment had statistical significance (P <0.05). 3. After therapy, the pulmonary function (FEV1,FEV1/FVC,PEF)of the two groups was improved (P <0.05); and the parameters of observation group was obvious higher than that of control group (P <0.05). 4. The parameters after therapy in artery blood gas analysis of the two groups was better than before (P <0.05), abservation group with obvious improvement; The difference of PaCO2, SaO2 and PaO2in observation group had obviously improved compared with control group (P <0.05), PH with no statistical significance (P >0.05). 5. The ratio of hospital discharge , tracheal intubation and fatality in observation group has no statistical significance compared with the control group (P >0.05), mean days of hospitalization with statistical significance (P <0.05). Conclusions1. BiPAP can efficiently improve the lung function of patients with medium and severe asthma. 2. The level of PaO2and SaO2 obviously rises, and the level of PaCO2 markedly decreases, after treatment by applying BiPAP. 3. Combination of conventional therapy and BiPAP is an efficient method in the treatment asthma, especially for the medium and severe asthma. 4. However, it is not better than IPPV for some severe asthma with unconsciousness, much airway excretion, low lung compliance.
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