title: Positive Expiratory Pressure for the Treatment of Acute Asthma Exacerbations: A Randomized Controlled Trial.
abstract: To evaluate the efficacy of brief, single administration of positive expiratory pressure (PEP) therapy in reducing clinical severity and need for additional second-line therapies and hospitalization in children presenting to the emergency department (ED) with acute asthma.
  
  
  
  This was a prospective randomized controlled trial of children 2-18 years of age presenting to a tertiary-care academic pediatric ED with moderate-to-severe asthma exacerbations from December 2014 to June 2016. Children who continued to have moderate asthma severity after completion of initial therapies (albuterol/ipratropium bromide and corticosteroids) were randomized to receive PEP therapy or standard of care. The primary outcome was change in pulmonary asthma score before and after intervention, as assessed by a blinded physician. Secondary outcomes included need for additional therapies, ED length of stay, and disposition.
  
  
  
  A total of 52 patients were randomized to receive either PEP (n?=?26) or standard therapy (n?=?26). Study groups were similar in demographics and baseline characteristics. There was no significant difference in primary outcome between groups with a mean change in Pulmonary Asthma Score of 0.92 (±1.2) in the PEP group and 0.40 (±1.2) in the standard group (P?=?.12). There also was no significant difference in need for additional therapies, ED length of stay, and disposition. Mild, self-resolving side effects were observed in 3 subjects receiving PEP therapy.
  
  
  
  Single, brief, administration of PEP therapy after completion of first-line therapies does not improve clinical severity in children presenting to the ED with acute asthma.
  
  
  
  ClinicalTrials.gov: NCT02494076.
authors.affiliation: Children's Hospital Colorado, University of Colorado School of Medicine, Section of Pediatric Emergency Medicine, Aurora, CO. Electronic address: Nidhya.Navanandan@childrenscolorado.org.
authors.forename: Nidhya
authors.initials: N
authors.lastname: Navanandan
authors.affiliation: Children's Hospital Colorado, University of Colorado School of Medicine, Section of Pediatric Pulmonary Medicine, Aurora, CO.
authors.forename: Monica
authors.initials: M
authors.lastname: Federico
authors.affiliation: Children's Hospital Colorado, University of Colorado School of Medicine, Section of Pediatric Emergency Medicine, Aurora, CO.
authors.forename: Rakesh D
authors.initials: RD
authors.lastname: Mistry
mesh_terms: D000420:Albuterol / Q000627:therapeutic use; D001249:Asthma / Q000628:therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy; D004636:Emergency Service, Hospital; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D009241:Ipratropium / Q000627:therapeutic use; D008297:Male; D009330:Nebulizers and Vaporizers; D011175:Positive-Pressure Respiration; D011241:Prednisone / Q000627:therapeutic use; D011446:Prospective Studies; D012720:Severity of Illness Index; D016037:Single-Blind Method
chemical_list: D001993:Bronchodilator Agents; D005938:Glucocorticoids; D009241:Ipratropium; D000420:Albuterol; D011241:Prednisone
keywords: asthma severity; respiratory; therapies; wheeze