Practice Based Learning: In which asthmatic children should we start PEP on admission, and in which children do we not need to start PEP?

Lauren Levy, MD

Presented by Lauren Levy, MD
Resident, Department of Pediatrics
Emory University

Key Points:

  • Use of PEP in combination with nebulized bronchodilators is useful in increasing delivery and distribution (as evidenced by a study utilized scintigraphy) of the drug in an outpatient setting, and may be extrapolated to have benefits in the acute care setting as well.
  • Other types of NiPPV (such as BIPAP) have been shown to improve outcomes in acute presentations in asthmatics, likely by stenting airways and improving drug delivery, along with decreasing atelectasis and air trapping. This has been shown to decrease length of ICU stays as well as to lower the mean dose of the bronchodilator needed.
  • More studies need to be conducted to look at the use of PEP with bronchodilators specifically in the ED and inpatient setting to evaluate its potential benefits.


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