Second, the low rate of NIV use in some hospitals may be due to the lack of strong evidence for NIV use in patients with respiratory failure resulting from asthma exacerbations. However, we believe that the small sample sizes of the currently available studies do not allow proper conclusions to be formed in this area, and as such this may affect clinicians' confidence in the therapy, knowledge, and experience in this group of patients. Factors known to influence NIV success are varied and often depend on patient characteristics, equipment, and skills of the team applying NIV. The location of NIV application is also an important factor in the success of treatment, as there may be great variation in monitoring and response to therapy between the emergency department, general ward, and intensive care unit. The current study by Stefan et al concluded that NIV use did not reduce progression to invasive mechanical ventilation in asthma exacerbations. However, we believe that assessment of NIV use skills and familiarity with therapy would be useful for improving confidence in NIV use among different hospitals. Further studies are needed to establish critical factors that influence hospitals’ patterns of use of NIV in patients with asthma exacerbations.