As the COVID-19 pandemic evolves, the medical community is adapting to the best ways to practice medicine in the face of this very contagious virus.   One concern has been the risk of spreading the virus during a nebulizer treatment. This has been especially important in the hospital setting because patients may have several healthcare workers in their room during or after a breathing treatment. Due to this concern, hospitals have switched entirely away from using nebulizers and instead are using metered dose inhalers to deliver medications such as albuterol.

There are questions about whether we should universally stop using nebulizers at home as well. The answer, like so many questions around COVID-19, is less clear.

For many patients using an albuterol inhaler delivered with a spacer device (or otherwise excellent technique) may result in the same symptom improvement as a nebulizer. Therefore, patients at home should start with albuterol given via the inhaler with a spacer. For our youngest patients, delivery of medications (albuterol or inhaled steroids) via an inhaler and spacer may or may not work well, but it is certainly worth trying an inhaler with spacer as our starting point.

Additionally, there are many other explanations and triggers for asthmatic symptoms, beyond COVID-19, which may necessitate the delivery of medications via a nebulizer.

At this time we recommend that when the MDI inhaler is NOT improving symptoms,  a nebulizer delivery may be tried with the following considerations:

• For patients who live alone, using a nebulizer would be at low risk for infecting others.
• For older children or adults, consider identifying a dedicated room with a door in which to use the nebulizer. Only the patient should use the room and other household members should avoid that room.
• For our youngest patients, we should consider a dedicated room as well (as described above) and then also choose a caregiver at the lowest risk. Specifically, we should avoid exposing caregivers whose age is greater than 60 years or who have other medical issues which would identify them as “high risk” for serious complications associated with COVID-19 infection.

We will continue to update our information as more current and possibly relevant data becomes available. As always, please feel free to contact our office directly with specific questions relating to your health.

– Lora Stewart MD