Non-invasive Ventilation vs. Standard Therapy for Children Hospitalized With an Acute Exacerbation of Asthma

Inclusion Criteria: * 2-18 years old * Clinical diagnosis of acute asthma exacerbation (respiratory rate greater than WHO's age-dependent criteria, a history of similar previous episodes and wheezing heard on auscultation by an experienced physician) * PRAM score of 8 or more after 2 hours post-steroid administration * Parents willing and able to sign consent * Children over the age of 6 willing to provide assent Exclusion Criteria: * Clinical suspicion of bacterial pneumonia: focal crackles or bronchial breathing, and/or major chest x-ray findings. * Impending respiratory failure at presentation requiring direct PICU admission * Any contraindication to BiPAP use including altered mental status, recent bowel surgery, intractable vomiting, inability to protect airway, pneumothorax. * Receiving maintenance dose of oral steroid at time of hospital admission * History of serious unrelated illness such as congenital heart disease or bronchopulmonary dysplasia.