{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T02:03:48Z","timestamp":1788401028146,"version":"build-2803163510"},"reference-count":37,"publisher":"European Respiratory Society (ERS)","issue":"178","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir Rev"],"accepted":{"date-parts":[[2025,10,5]]},"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:p>\n                    The management of asthma exacerbations is well established, including inhaled short-acting \u03b2\n                    <jats:sub>2<\/jats:sub>\n                    -agonist administration, systemic corticosteroid therapy and supplemental oxygen. Severe asthma exacerbations (SAEs) nonresponsive to medical and O\n                    <jats:sub>2<\/jats:sub>\n                    therapy may require mechanical ventilation\n                    <jats:italic>via<\/jats:italic>\n                    endotracheal intubation (ETI), evaluation and admission to the intensive care unit (ICU). However, up to 35% of intubated and ventilated patients die due to conventional mechanical ventilation (CMV)-related life-threatening complications (\n                    <jats:italic>i.e.<\/jats:italic>\n                    barotrauma, circulatory collapse, cardiac arrhythmias, acute coronary syndrome, atelectasis and pneumonia). Among noninvasive respiratory therapies, the effectiveness of noninvasive ventilation (NIV) in preventing clinical deterioration and CMV in the earlier phases of SAE remains controversial. Limited tolerance to mechanical ventilation represents a drawback that can compromise treatment success. The high-flow nasal cannula (HFNC) is a widely applied respiratory supportive tool for the management of several patterns and types of acute respiratory failure, with patient acceptance being a key point favouring its application. Despite a potential pathophysiological rationale, clinical data on the feasibility and effectiveness of HFNC in SAEs are lacking. We conducted this concise narrative review to summarise the physiological and clinical benefits of HFNC compared to conventional oxygen therapy (COT) in adult patients with SAEs, focusing on outcomes such as dyspnoea, comfort, lung gas exchange, facilitation of inhaled therapy, hospitalisations, ETI and ICU admission. According to available data, there is no evidence of either superiority or inferiority of HFNC\n                    <jats:italic>versus<\/jats:italic>\n                    COT in SAEs. Further larger randomised control trials are required to define the role of HFNC in asthmatic attacks.\n                  <\/jats:p>","DOI":"10.1183\/16000617.0109-2025","type":"journal-article","created":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T09:30:15Z","timestamp":1765963815000},"page":"250109","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["High-flow nasal cannula in severe asthma exacerbations: current evidence and clinical perspectives"],"prefix":"10.1183","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2538-1278","authenticated-orcid":false,"given":"Lorenzo","family":"Carriera","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2838-423X","authenticated-orcid":false,"given":"Simone","family":"Ielo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Barone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Lipsi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"Coppola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0637-7282","authenticated-orcid":false,"given":"Andrea","family":"Smargiassi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Inchingolo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Richeldi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaele","family":"Scala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2025,12,17]]},"reference":[{"key":"2025121809151398000_34.178.250109.1","unstructured":"Global Initiative for Asthma . Global strategy for asthma management and prevention. Date last updated: May 2024. 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Potential novel role of asthma biologics as rescue therapy in the intensive care unit for life-threatening asthma exacerbations: a systematic review. 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Early high-flow oxygen therapy with nebulized beta-2-agonist using a vibrating mesh for the management of moderate to severe asthma exacerbation in the emergency department (EOLE). Date last updated: 6 June 2025. Date last accessed: 24 November 2024. https:\/\/clinicaltrials.gov\/study\/NCT05691218"},{"key":"2025121809151398000_34.178.250109.26","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1111\/acem.14187","article-title":"Nasal high-flow oxygen versus conventional oxygen therapy for acute severe asthma patients: a pilot randomized controlled trial","volume":"28","author":"Ruangsomboon","year":"2021","journal-title":"Acad Emerg Med"},{"key":"2025121809151398000_34.178.250109.27","first-page":"2301712","article-title":"High-flow nasal cannula: a promising oxygen therapy for patients with severe bronchial asthma complicated with respiratory failure","volume":"2020","author":"Geng","year":"2020","journal-title":"Can Respir J"},{"key":"2025121809151398000_34.178.250109.28","first-page":"615","article-title":"Value and safety of high flow oxygenation in the treatment of inpatient asthma: a randomized, double-blind, pilot study","volume":"18","author":"Raeisi","year":"2019","journal-title":"Iran J Allergy Asthma Immunol"},{"key":"2025121809151398000_34.178.250109.29","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.jaip.2022.09.008","article-title":"Clinical associations of mucus plugging in moderate to severe asthma","volume":"11","author":"Chan","year":"2023","journal-title":"J Allergy Clin Immunol Pract"},{"key":"2025121809151398000_34.178.250109.30","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.5114\/ada.2022.119074","article-title":"The efficacy of high-flow oxygen versus conventional oxygen for asthma control: a meta-analysis of randomized controlled studies","volume":"39","author":"Deng","year":"2022","journal-title":"Postepy Dermatol Alergol"},{"key":"2025121809151398000_34.178.250109.31","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.jpeds.2017.10.075","article-title":"Pilot clinical trial of high-flow oxygen therapy in children with asthma in the emergency service","volume":"194","author":"Ballestero","year":"2018","journal-title":"J Pediatr"},{"key":"2025121809151398000_34.178.250109.32","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1186\/s13054-020-03206-9","article-title":"A narrative review on trans-nasal pulmonary aerosol delivery","volume":"24","author":"Li","year":"2020","journal-title":"Crit Care"},{"key":"2025121809151398000_34.178.250109.33","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00900-2019"},{"key":"2025121809151398000_34.178.250109.34","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.02426-2016"},{"key":"2025121809151398000_34.178.250109.35","first-page":"630","article-title":"Noninvasive ventilation in severe acute asthma? Still far from the truth","volume":"55","author":"Scala","year":"2010","journal-title":"Respir Care"},{"key":"2025121809151398000_34.178.250109.36","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1513\/AnnalsATS.201604-279ED","article-title":"Noninvasive ventilation for acute asthma. \u201cSpill-over\u201d or \u201clighted windows\u201d?","volume":"13","author":"Scala","year":"2016","journal-title":"Ann Am Thorac Soc"},{"key":"2025121809151398000_34.178.250109.37","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0029-2018"}],"container-title":["European Respiratory Review"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1183\/16000617.0109-2025","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T17:15:28Z","timestamp":1766078128000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.ersnet.org\/lookup\/doi\/10.1183\/16000617.0109-2025"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":37,"journal-issue":{"issue":"178","published-online":{"date-parts":[[2025,12,17]]},"published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1183\/16000617.0109-2025"],"URL":"https:\/\/doi.org\/10.1183\/16000617.0109-2025","relation":{},"ISSN":["0905-9180","1600-0617"],"issn-type":[{"value":"0905-9180","type":"print"},{"value":"1600-0617","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10]]}}}