Podcast 992: Fentanyl for Asthma

Contributor: Alec Coston, MD

Educational Pearls:

BiPAP is often effective in severe asthma, but many patients struggle with mask tolerance due to intense air hunger–driven anxiety, often compounded by hypoxia.

Benzodiazepines are commonly used for anxiety, but they can depress respiratory drive, making clinical improvement difficult to interpret (a lower RR may reflect sedation rather than true physiologic improvement).

Low-dose fentanyl is a useful alternative when patients cannot tolerate BiPAP despite coaching.

Opioids blunt the perception of dyspnea and are well established for treating air hunger.

Wh...