key: cord-0699297-31g2b8co
authors: Anzueto, Antonio; Smyth, Hugh DC
title: Letter to the Editor in response to the article: “Nebulization: A potential source of SARS-CoV-2 transmission”
date: 2020-11-17
journal: Respir Med Res
DOI: 10.1016/j.resmer.2020.100802
sha: 4bdd16a27d5af9881b689b31df5193e5afbc3db9
doc_id: 699297
cord_uid: 31g2b8co

nan

1 Letter to the Editor in response to the article: "Nebulization: A potential source of SARS-

Antonio Anzueto, MD 1 A recent editorial in Respiratory Medicine and Research entitled "Nebulization: A potential source of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission" by G Reychler et al. [1] itemized a series of concerns using nebulizers for drug delivery, to which we feel some additional perspective is needed. Current use of nebulized therapy must be placed within the context of treatments used early during the current pandemic and how a patient's condition and setting should dictate the manner in which nebulized therapy should be prioritized.

In the early stages of the pandemic, some cases of SARS-CoV-2 transmission in healthcare facilities occurred because healthcare providers (HCPs) were not properly protected at the time of patient admission [2] . First and foremost, when an individual enters a hospital or clinic for treatment, HCPs should strictly adhere to measures that prevent the transmission of the virus to themselves and others.

The SARS-CoV-2 pandemic has upended how HCPs approach the treatment of patients with respiratory diseases. Although the risk of exposure to SARS-CoV-2 by HCPs is a primary concern, it is also important to keep in mind that there is a need to provide appropriate therapy for patients with a respiratory disease. In some patients, nebulized therapy is the only option available for their inhaled medications. In the current situation, patients with coronavirus disease 2019 (COVID-19) and comorbid with respiratory disease may be provided hand-held devices, such as metered-dose inhalers (MDIs), for the delivery of their respiratory medications, as an alternative to nebulized therapy. Patients unaccustomed to MDIs or those unable to appropriately use MDIs may not receive appropriate pharmacological therapy from their hand-held inhalers [3] . Patients with poor inhalation-actuation coordination, insufficient inspiratory strength, or other physical or mental impediments may also not derive the full benefits of MDIs. Therefore, nebulized therapy is another option for these patients. However, to prevent transmission of SARS-CoV-2 to others, this patient must adhere to quarantine guidelines and take extra precautions, such as avoiding the use of a nebulizer in the presence of other people and undergoing their treatments in well-ventilated areas outside the living quarters. The nebulizers should also be cleaned and disinfected or sterilized according to the manufacturer's instructions after each use [4] . The use of a filter with the nebulizer may limit the risk of virus transmission, although this matter has not been settled [3] . The most current recommendation by the National Institute for Health and Care Excellence [5] , the United Kingdom public health guidance [6] , and the International Society of Aerosols in Medicine [4] is that patients should be placed in a negative pressure room before nebulized therapy is initiated. All HCPs in the vicinity also must continue using their personal protective equipment and observe sanitization protocols.

It is imperative that people with respiratory disease be able to maintain their therapy to prevent exacerbations, thereby reducing the risk of hospitalization and nosocomial SARS-CoV-2 infection.

Although we agree that all measures should be undertaken to prevent the spread of SARS-CoV-

group Aerosoltherapy GAT of the French Language Respiratory Society Société de Pneumologie de Langue Française SPLF. Nebulization: A potential source of SARS-CoV-2 transmission

Transmission of COVID-19 to health care personnel during exposures to a hospitalized patient

Use of aerosolised medications at home for COVID-19

Reducing aerosol-related risk of transmission in the era of COVID-19: an interim guidance endorsed by the International Society of Aerosols in Medicine

Epub ahead of print

National Institute for Health and Care Excellence. COVID-19 rapid guideline: communitybased care of patients with chronic obstructive pulmonary disease (COPD)

infectionprevention-and-control/covid-19-infection-prevention-and-control-guidance-aerosolgenerating-procedures

Global Initiative for Chronic Obstructive Disease (GOLD) 2020 report