{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:21:12Z","timestamp":1787761272849,"version":"build-2784847793"},"reference-count":38,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n A substantial knowledge gap remains in understanding the specific role bilevel positive airway pressure (BPAP) in the emergency department (ED) for acute pediatric asthma exacerbations.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine whether the early application of BPAP in the ED for acute pediatric asthma exacerbations reduces duration of critical care management time.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This double-blind randomized clinical trial enrolled children between 5 and 17 years of age presenting to a single-center, quaternary, referral pediatric ED with an acute asthma exacerbation, a pediatric respiratory assessment measure of at least 4 (moderate severity), and prescribed continuous albuterol therapy between June 1, 2023, and May 31, 2025.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Participants were randomized to either the intervention arm (BPAP) or control arm (sham BPAP, which delivers minimal pressure) for 4 hours. Neither the health care practitioners nor participants were aware of study arm allocation.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome and Measures<\/jats:title>\n \n The primary outcome measure was duration of continuous albuterol therapy. A sequential design with a planned interim analysis for futility and superiority was used, and a\n t<\/jats:italic>\n test compared mean duration of continuous \u03b2-agonist therapy under an intention-to-treat approach.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Sixty-six study participants (median [IQR] age, 10.2 [6.8-13.2] years; 35 [53.0%] male; 1 [1.5%] American Indian or Alaskan, 1 [1.5%] Asian, 21 [31.8%] Black or African American, 21 [31.8%] White, and 22 [33.3%] other race) were included in the primary analysis, with a mean (SD) pediatric respiratory assessment measure of 5.2 (1.9), indicating moderate disease. At the 50% interim analysis, participants in the BPAP study arm received a mean (SD) of 8.3 (8.5) hours of continuous albuterol vs 8.7 (10.0) hours in the control group (mean difference, \u22120.5 hours; 95% CI, \u22125.0 to 4.1 hours;\n P<\/jats:italic>\n \u2009=\u2009.84). The study was stopped due to meeting a priori bounds for futility at the 50% interim analysis. No deaths, invasive mechanical ventilation, air leak syndrome, or aspiration pneumonia were observed in either study arm.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this randomized clinical trial of early initiation of BPAP in the ED, no clinically significant decrease in the duration of continuous \u03b2-agonist therapy in pediatric patients presenting with moderate asthma exacerbations was observed. Additional open-label studies in a more severe asthma cohort are required to better inform clinical practice.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT05848115<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.30627","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:30:36Z","timestamp":1787758236000},"page":"e2630627","source":"Crossref","is-referenced-by-count":0,"title":["Bilevel Positive Airway Pressure and Continuous Albuterol for Pediatric Asthma Exacerbations"],"prefix":"10.1001","volume":"9","author":[{"given":"Patrick T.","family":"Wilson","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of Colorado Anschutz School of Medicine, Aurora"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melisa","family":"Tanverdi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of 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