What is the recommended treatment for severe asthma that fails to respond to standard therapies?

The recommendation to consider BiPAP (bilevel positive airway pressure) for severe asthma that is unresponsive to standard therapies is based on the understanding that patients experiencing significant respiratory distress may benefit from non-invasive ventilation. In cases of severe asthma exacerbations, especially where there is hypercapnia or respiratory fatigue, BiPAP can provide support by improving ventilation and aiding in the reduction of the work of breathing.

The use of BiPAP helps to maintain airway patency and can enhance the patient's overall respiratory mechanics, allowing for better gas exchange. This intervention is particularly important in severe cases where there is a risk of respiratory failure, as it can prevent the need for intubation and invasive mechanical ventilation.

In contrast, continuing oral corticosteroids may not provide immediate relief during an acute exacerbation, high-dose inhalation therapies may not be adequate alone without the assistance of ventilation, and systemic antihistamines are not a frontline treatment for asthma exacerbations. Thus, BiPAP stands out as a critical supportive measure in managing acute respiratory distress in severe asthma cases.