This webinar first aired on July 9, 2020

Summary

A discussion on the use of inhalers and nebulizers during the COVID-19 outbreak that centers on how to manage inhalers and nebulizers in the home, school and hospital settings. Additional information includes resources that are available to help patients better afford their medications.

Webinar Objectives

Following this webinar, the participant will be able to:

  • Discuss asthma care at home during COVID-19, including the use and cleaning of nebulizers
  • Identify 3 concerns related to using inhalers at school
  • Identify aerosol generating procedures in the hospital / medical office setting and strategies to mitigate the spread of viral droplets

Speakers

Dr. Purvi Parikh
Tonya Winders, President and CEO of Allergy & Asthma Network

Resources

CE is not available for this webinar


Question and Answers from the Webinar

What are some of the common respiratory tools used for patients with asthma?

Metered-dose inhalers (MDI), dry powder inhalers (DPI) and soft-mist inhalers are the three types of asthma inhalers, with valved holding chambers or spacers serving as devices that can help facilitate the medication. Nebulizers are devices that deliver asthma medication into a fine aerosol that can be inhaled into the lungs.

A spirometer is a device that measures the volume and speed that air is pushed in and out of the lungs. Peak flow meters are used to measure the speed you can force air out of your lungs. A fractional exhaled nitric oxide (FeNO) device measures exhaled nitric oxide to gauge airway inflammation.

For more information about all of these devices and tools, see Asthma Medications and Treatment.

What is the best defense against COVID-19 for people with asthma?

Make sure your asthma is well controlled. This is important all the time, but even more important during the pandemic. Based upon current data, those most at risk from severe illness from COVID-19 include:

  • People with chronic lung disease or moderate-to-severe asthma
  • People who are immunocompromised, including those on oral corticosteroids
  • People of any age with certain underlying health conditions, particularly if those conditions are not well controlled.

What are some of the issues with COVID-19 with regards to respiratory tools?

COVID-19 is spread through droplets, and emerging research suggests that it may also linger in the air. Inhalers, nebulizers and spacers may contain COVID-19 respiratory droplets and nebulizers can spread droplets through the air.

It is important to continue to access asthma care during the COVID-19 pandemic. Telehealth may be especially useful for asthma patients.

What are some important things to remember about asthma care during this time?

Make sure that your asthma is under control. Here are some tips on how to manage asthma:

  • Check that you are on the right medication and right dose
  • Make sure you are using proper technique for all inhaled medications
  • Know when to call the hospital or ER if you are having trouble breathing
  • Know your warning signs
  • Understand the importance of taking daily asthma controller medications
  • Use both your quick-relief inhaler and controller medications as directed
  • If possible, get a 90-day supply of your medications

How should nebulizers be used at home in people with known or suspected COVID-19?

Nebulizers should be used in an area that limits exposure to other household members. Consider a location where the air is not circulated into the home – a porch, patio, garage or even near an open window.

Keep the nebulizer clean – follow manufacturer instructions. Cleaning recommendations include:

  • Take apart the nebulizer and clean all pieces (except tubing and finger valve) in dish soap and water
  • After washing, shake off excess water
  • Reattach pieces and tubing to the air compressor and turn on to allow for quick drying
  • Do not store nebulizer until completely dry

How should respiratory tools be used at school during COVID-19?

When permitted by school policies or state law, students should be allowed to use their personal inhaler.

All surfaces of the inhaler should be cleaned after each use with an alcohol-based wipe containing 70% or greater alcohol and then allowed to airdry. Both spacers and valved holding chambers must be cleaned with each use according to manufacturer instructions.

Staff who administer inhalers need to practice good hand hygiene – washing with soap and water for 20 seconds or using an alcohol-based cleanser containing 60% alcohol or greater.

During the pandemic, asthma treatments using inhalers with spacers are the preferred method

  • Nebulizers should be reserved for students who cannot use an inhaler or don’t have access to one. If used, staff must wear appropriate PPE and use nebulizer in an isolated room (preferably near an open window).
  • Follow cleaning procedures for cleaning nebulizers, if used.

If a stock albuterol inhaler is used by a student to treat an asthma flare, it must be immediately cleaned after each use according to manufacturer instructions.

Peak flow meters may pose a risk as they involve exhaling air forcefully and may produce a cough with respiratory droplets that can spread through the air.

What are considerations for hospitals, clinics and doctor’s offices?

Hospitals may reuse MDIs, but they should be dedicated to a single patient during their hospitalization. If MDIs are reused, they must first be sterilized.

The main concern for transmission of COVID-19 in medical settings is aerosol-generating procedures (AGP) including:

  • Suctioning of airways
  • Sputum induction
  • CPR
  • Intubation and extubation
  • Non-invasive ventilation (such as CPAP/BIPAP)
  • Manual ventilation

If AGPs are performed, PPE must be worn by all staff (N95 masks or high-level respirator, gloves, gowns, eye protection). The hospital should limit number of people in the room to essential personnel only and ideally the procedure should be performed in an airborne infection isolation room (AIIR).

Dedicated medical equipment should be used for patients with confirmed or suspected COVID-19. For non-dedicated or non-disposal equipment, cleaning and disinfecting must be done after each use per manufacturer instructions.

Routine cleaning and disinfection must occur throughout the hospital using EPA-registered hospital-grade disinfectants.

Spirometry and FeNO testing are potentially AGPs, so use only if they are essential for treatment decisions and doctors and nurses wear appropriate PPE. Increasing levels of fractional exhaled nitrous oxide (FeNO) may be an early indicator of the presence of COVID-19.

What are some key points to take away for nebulizer use in the hospital?

If a nebulizer is needed, all staff present must wear appropriate PPE and door must be closed during treatment. If possible, once the nebulizer is set up, staff should step at least 6 feet away or outside the closed door.

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