Aims To examine whether bilevel positive airway pressure (BiPAP) for children with acute asthma exacerbations not approaching respiratory failure (not meeting NIH and GINA guidelines for noninvasive ventilation) is associated with improved clinical outcomes.

Methods We prospectively enrolled children 5–17 years with exacerbations not meeting respiratory failure guidelines for BiPAP use in a paediatric emergency department. We modelled propensity scores for BiPAP treatment then used propensity score matching to estimate the associations of BiPAP treatment with hospital admission; PICU admission; hospital length-of-stay; and time to Q4 hr albuterol as a metric of clinical improvement.

Results Amongst 933 participants, median [IQR] age was 8.8[6.9,11.2] years, male 61%, and African-American 59%. BiPAP-treated participants (n = 45) had similar demographic characteristics to BiPAP-untreated participants in the matched analysis and significantly greater likelihood of hospital and PICU admission (Table ).

Conclusions BiPAP treatment for paediatric patients with asthma exacerbations not meeting respiratory failure guidelines may be associated with greater resource utilisation without evidence of improved outcomes.