key: cord-0783410-2b3hf8os
authors: Hess, Michael W
title: Nebulized Therapy in the COVID-19 Era: The Right Tool for the Right Patient [Letter]
date: 2020-09-07
journal: Int J Chron Obstruct Pulmon Dis
DOI: 10.2147/copd.s272382
sha: 89beaa367b128b2e0b841038d4ce181f8e030cf5
doc_id: 783410
cord_uid: 2b3hf8os

nan

Advisory Group (NERVTAG) recommend the continued use of nebulizers because the aerosols produced by them are generated from fluid within the nebulizer chamber that does not carry patient-derived viral particles. If a particle in the aerosol coalesces with contaminated mucous membrane, it ceases to be airborne and therefore will not be aerosolized. 4 The Global Initiative for Chronic Obstructive Lung Disease advises that patients with chronic obstructive pulmonary disease maintain their regular therapy and recommends nebulizers for those who need them and MDIs for patients who are suitable for them. 5 At present, only a few studies have investigated the risk of aerosol-generating treatments spreading any type of coronavirus. A 2012 assessment of three cohort studies investigating the transmission of coronavirus to healthcare personnel during the 2002-2003 SARS-CoV outbreaks found no significantly elevated risk of SARS-CoV transmission to healthcare workers caring for patients undergoing nebulizer treatment. 6 A recent article by Dr Arzu Ari indicates that, while unnecessary aerosol therapy should continue to be avoided, the risk of viral transmission can be minimized with basic precautions. 7 Although limited, these studies suggest that there is no compelling reason to alter aerosol modality for patients with established nebulizer-based regimens.

Guidance for the treatment of patients with respiratory disease during the SARS-CoV-2 pandemic is rapidly evolving as new details of viral transmission are being elucidated. At present, data on whether nebulized treatment represent an infection transmission risk are limited. Moving forward, it will be important to follow evidencebased treatment procedures using the right-tool-for-theright-patient approach and to not overreact based on assumptions, which could lead to future shortages of medical resources as well as possible suboptimal outcomes related to medication delivery and patient-related factors. 

The International Journal of COPD is an international, peer-reviewed journal of therapeutics and pharmacology focusing on concise rapid reporting of clinical studies and reviews in COPD. Special focus is given to the pathophysiological processes underlying the disease, intervention programs, patient focused education, and self management protocols. This journal is indexed on PubMed Central, MedLine and CAS. The manuscript management system is completely online and includes a very quick and fair peer-review system, which is all easy to use. Visit http://www.dovepress.com/testimonials.php to read real quotes from published authors. Submit your manuscript here: https://www.dovepress.com/international-journal-of-chronic-obstructive-pulmonary-disease-journal 

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Medical writing support was funded by Theravance Biopharma US, Inc. (South San Francisco, CA, USA). The authoracknowledges Gautam Bijur, PhD, for medical writing and Frederique H. Evans, MBS, for editorial assistance (both from Ashfield Healthcare Communications) in the preparation of the document.

Michael Hess has received consultation/speaking fees from Theravance/Mylan, Boehringer-Ingelheim, and Olympus America (Medical). The author reports no other conflicts of interest in this communication.