Pediatric asthma creates a tremendous burden on children, families, and medical systems. In the United States, one of every 14 individuals below the age 18 suffers from asthma; in total, over 5 million children are affected. For children with asthma exacerbations, there are approximately 750,000 emergency department visits and 74,000 hospital admissions/y, contributing to the nearly $6 billion in yearly costs attributable to pediatric asthma.1,2 Whereas asthma is rarely fatal in children, many children with an asthma exacerbation will develop severe respiratory distress that requires respiratory support.3,-,5 Noninvasive respiratory support (NRS) devices, including CPAP, noninvasive ventilation (NIV), and high-flow nasal cannula (HFNC), are increasingly utilized forms of respiratory support to treat respiratory distress in lieu of intubation and invasive mechanical ventilation. In general, CPAP and NIV offer a higher form of respiratory support, whereas HFNC is thought to be more comfortable for patients and result in less barotrauma. However, as the use of NRS has increased, respiratory therapists and physicians have been left to make decisions about its implementation without high-quality evidence to guide practice. Multiple prior retrospective studies have compared the use of NIV with HFNC in pediatric asthma exacerbations.6,-,8 However, prior studies have been small, with < 100 subjects; and overall, evidence to guide use of HFNC versus NIV in pediatric asthma is limited.

In this issue of Respiratory Care, Russi et al9 describe a large cohort of children with critical asthma managed with NRS. Using a high-quality international database of pediatric ICU (PICU) patients, the authors conducted a descriptive retrospective study of children ages …

Correspondence: Benjamin White MD MA. E-mail: benjaminrobertwhitegmail.com