Asthma remains one of the top three causes of hospitalization in children in the United States. Interventions that rapidly reverse bronchial obstruction and decrease the need for continuous beta-agonist therapy will not only directly benefit the patient, but also decrease the consumption of acute care resources. Bilevel positive airway pressure (BPAP) is a form of non-invasive positive pressure ventilation that may stent open airways, improve mucous clearance, recruit alveoli, and increase responsiveness to continuous beta-agonist therapy in the small distal airways. However, BPAP is not currently part of the NIH guidelines for the management of pediatric acute asthma secondary to the lack of quality pediatric clinical trials. The goal of this prospective, randomized, double blind, controlled trial is to determine if early initiation of BPAP is effective and safe in pediatric patients presenting to a pediatric emergency department with acute moderate to severe asthma exacerbations who fail first line therapy.