Ventilatory Management in Acute Asthma Exacerbations: Worldwide Current Beliefs and Practices

Acute Severe Asthma (ASA) affect 25-56% of patients with asthma, with severe cases accounting for 8% of ICU admissions. <bold>Objectives:</bold> This study aims to explore physicians' attitudes, and ventilatory management practices. <bold>Methods:</bold> observational cross-sectional questionnaire-based survey targeting physicians involved in ASA patients. Data were collected via an online survey using Google Forms. The study assessed ventilatory management , invasive mechanical ventilation (IMV) and noninvasive (NIV) ventilation, appropriate settings, barriers and potential complications. <bold>Results:</bold> Ninety-three responses were received across Middle East-North Africa (59.1%), Europe (13.9%), South/East Asia (12.9%), Central/South America (7.5%), and North America (6.7%). Jet nebulizers were preferred by 59.4% Mouthpieces with jet nebulizers and mesh nebulizers were 'never' or 'infrequently' used by 59.1% and 52.8%. Oxygen therapy was used by 59.1%, HFNC was available to 93.5%, but 23.6% 'never" or "infrequently' used it, particularly due to unavailability (46%) or lack of experience (34.2%). ASA severity guided the HFNC vs. NIV choice for 81.4%, though 34% considered patient preference. NIV was available to 98.9% and 'usually' or 'mostly' used (82.7%), Appropriate NIV settings were identified by 43%, while others used inappropriate PEEP, RR, or cycling criteria. The worst prognosis was expected in those who became intubated after NIV failure (67.4%), while 32.5% expected the worst outcomes for those initially intubated without a NIV. <bold>Conclusion:</bold> Physicians are divided regarding using predefined criteria or clinical judgment for diagnosing ASA and ICU referrals. Limited availability, unfamiliarity, and lack of experience hinder the use of HFNC and NIV.