How to ventilate obstructive and asthmatic patients

Intensive Care Med. 2020 Dec;46(12):2436-2449. doi: 10.1007/s00134-020-06291-0. Epub 2020 Nov 9.


Exacerbations are part of the natural history of chronic obstructive pulmonary disease and asthma. Severe exacerbations can cause acute respiratory failure, which may ultimately require mechanical ventilation. This review summarizes practical ventilator strategies for the management of patients with obstructive airway disease. Such strategies include non-invasive mechanical ventilation to prevent intubation, invasive mechanical ventilation, from the time of intubation to weaning, and strategies intended to prevent post-extubation acute respiratory failure. The role of tracheostomy, the long-term prognosis, and potential future adjunctive strategies are also discussed. Finally, the physiological background that underlies these strategies is detailed.

Keywords: Asthma; Chronic obstructive pulmonary disease; Intrisic positive end-expiratory pressure (PEEP); Mechanical ventilation; Non-invasive ventilation; Weaning.

Publication types

  • Review

MeSH terms

  • Asthma* / therapy
  • Humans
  • Pulmonary Disease, Chronic Obstructive* / complications
  • Pulmonary Disease, Chronic Obstructive* / therapy
  • Respiration, Artificial
  • Respiratory Insufficiency*
  • Respiratory Therapy
  • Ventilator Weaning