Early BPAP Did Not Shorten Albuterol Therapy in Pediatrics

Early bilevel positive airway pressure (BPAP) did not reduce the duration of continuous inhaled albuterol therapy in children with acute asthma exacerbations, according to a randomized clinical trial published in JAMA Network Open. Investigators found no statistically or clinically significant decrease in continuous albuterol duration compared with sham BPAP.

The single-center, double-blind trial enrolled 66 patients aged 5 to 17 years at a quaternary pediatric emergency department between June 2023 and May 2025. Participants had at least moderate asthma severity and had been prescribed continuous albuterol after first-line therapy. They were randomized to BPAP or sham BPAP, which delivered minimal pressure, for 4 hours.

Participants assigned to BPAP received continuous albuterol for a mean 8.3 hours, compared with 8.7 hours in the control group, with a mean difference of−0.5 hours (P=.84). The trial was stopped after meeting prespecified futility criteria at the 50% interim analysis.

No significant between-group differences were observed in asthma severity scores, vital signs over time, emergency department duration, hospital length of stay, pediatric intensive care unit admission, or adverse events. Neither group had deaths, invasive mechanical ventilation, air leak syndrome, or aspiration pneumonia.

The authors noted several limitations. Continuous albuterol duration is not a typical primary outcome in asthma trials, and hospitalization-related outcomes lacked standardized institutional criteria. Sham BPAP still delivered low pressures and heated, humidified gas, potentially providing physiologic benefit. BPAP use was limited to 4 hours, and albuterol delivery through the BPAP circuit reduced generalizability. The authors called for studies in children with more severe exacerbations.

Source: Wilson PT, Tanverdi M, Brinton JT, Ambroggio L, Szefler SJ. Bilevel positive airway pressure and continuous albuterol for pediatric asthma exacerbations: a randomized clinical trial. JAMA Netw Open. 2026;9(8):e2630627. doi:10.1001/jamanetworkopen.2026.30627