Effect of CPAP on airway reactivity and airway inflammation in children with moderate–severe asthma

Abstract

Background and objective: Asthma is characterized by airway hyperreactivity and airway inflammation. We previously demonstrated that adults with mild well-controlled asthma exhibited a marked decrease in airway reactivity (PC20 increased >2-fold) after using nocturnal continuous positive airway pressure (CPAP) for 1 week. If CPAP produces a similar suppression of airway reactivity in children with moderate–severe asthma, who require chronic use of corticosteroids, then this non-pharmacological therapy might provide a beneficial alternative or supplemental therapy in these subjects. Methods: Children aged 8–17 years with moderate–severe asthma were treated with 4 weeks of nocturnal CPAP (8–10 cm H2O) or sham CPAP (<2 cm H2O). Adherence was monitored with a modem installed in the equipment or by memory cards. Airway reactivity, assessed by methacholine bronchial challenge, was measured prior to and following treatment. Results: The percentage of subjects adherent to treatment was similar in both groups (19/27 CPAP vs 19/28 sham, ~70%). There was a tendency for PC20 to increase with treatment in both groups (3.0–5.3 mg/mL CPAP vs 3.2 to 4.3 mg/mL sham, P = 0.083); however, the change did not differ significantly between groups (P = 0.569). Conclusion: We found that the 4-week treatment with nocturnal CPAP did not produce a twofold suppression of airway reactivity in children with moderate–severe asthma. Clinical trial registration: at ClinicalTrials.gov

Continuous positive airway pressure acutely increases exercise duration in children with severe therapy-resistant asthma: a randomized crossover trial

“…Similarly, in adults with stable asthma, results showed that nighttime CPAP use for 7 days reduced airway reactivity [13]. Conversely, the use of nighttime CPAP (8-10 cmH 2 O) for 4 weeks in children and adolescents with moderate-to-severe asthma did not reduce airway reactivity in a methacholine-induced bronchoconstriction test [29]. Factors such as disease severity, age, time, and period of CPAP use may have been decisive for a lack of consensus on the effects of CPAP on physical performance.…”

CPAP treatment for asthma? A question worth pursuing further

“…Based on the results of the study by Holbrook et al . in 2016, the current study by Praca et al . is likely underpowered to show an effect of CPAP if one truly exists.…”

“…Extending the same line of research to paediatric asthma, in a recent publication in Respirology , Praca et al . present the findings of a small RCT of CPAP versus sham therapy for moderate to severe asthma in children aged 8–17 years . The authors used a 1‐month trial of CPAP at a pressure of 8–10 cm H 2 O compared to sham CPAP of 2 cm H 2 O and defined adherence using the typical cut‐off from adult studies of obstructive sleep apnoea (OSA) treatment of >4 h for >70% of nights.…”