Noninvasive Positive Airway Pressure in the Pediatric Emergency Department for the Treatment of Acute Asthma Exacerbations

Inclusion Criteria: * 2-18 years old * For subjects 3 years and older, a known history of asthma as diagnosed by the PCP or per the Vanderbilt problem list * For children ages 2-3 years, four or more episodes of wheezing in the past year that lasted more than 1 day and affected sleep AND one of the following: parental history of asthma, a physician diagnosis of atopic dermatitis, or evidence of sensitization to aeroallergens * Acute asthma exacerbation * Pediatric Asthma Score (PAS) ≥ 8 * Parents willing and able to sign consent * Children over the age of 6 willing to provide assent Exclusion Criteria: * History of congenital heart disease, chronic respiratory disease including bronchopulmonary dysplasia, cystic fibrosis, pulmonary hypertension or any chronic lung disease other than asthma * History of sickle cell disease * Recently diagnosed pneumonia * Current tracheostomy, on home ventilator or home oxygen requirement * Recent diabetic ketoacidosis * Requiring immediate intubation * Weight less than 5 kilograms * Any contraindication to BiPAP use including altered mental status, recent bowel surgery, intractable vomiting, inability to protect airway * A history of prematurity of ≤ 30 weeks gestation