Acute asthma management during SARS-CoV2-pandemic 2020

Area of Science:

• Pulmonology
• Infectious Disease
• Emergency Medicine

Background:

• The COVID-19 pandemic necessitates changes in medical practices to protect patients and healthcare providers.
• Telehealth and remote consultations have become more prevalent, but severe asthma exacerbations often require in-person evaluation and treatment.
• Traditional asthma treatment guidelines recommend metered dose inhalers (MDIs) with spacers, yet nebulized therapy remains preferred in many emergency settings.

Purpose of the Study:

• To address the increased risk of aerosolization and nosocomial transmission of SARS-CoV-2 associated with nebulized therapy during asthma exacerbations.
• To propose a risk stratification plan to guide the appropriate use of nebulized therapy versus MDIs in emergency departments.
• To mitigate the spread of respiratory pathogens in healthcare settings.

Main Methods:

• Development of a risk stratification algorithm to differentiate patients requiring nebulized therapy.
• Review of current emergency unit asthma guidelines and treatment preferences.
• Analysis of the potential for aerosol generation and infection spread with different delivery methods.

Main Results:

• Nebulized therapy for asthma exacerbations poses a significant risk for aerosolizing SARS-CoV-2, increasing the potential for nosocomial transmission.
• Current practices in many emergency units favor nebulizers over recommended MDI and spacer use for beta-agonist administration.
• A risk stratification plan can help identify patients who can be safely treated with MDIs, reducing nebulizer use.

Conclusions:

• Implementing protocols that favor MDI use over nebulizers for all but the most severe asthma exacerbations can reduce infection transmission risks.
• Expedient high-dose MDI therapy, combined with early systemic treatment, may prevent deterioration requiring nebulizers.
• Adopting these strategies enhances patient and healthcare provider safety during the COVID-19 pandemic.