The use of nebulized pharmacotherapies during the COVID-19 pandemic

Abstract

Coronavirus disease 2019 (COVID-19), caused by the highly contagious novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in a worldwide pandemic and currently represents a major public health issue. COVID-19 has highlighted the need for clear and accurate guidance on the use of aerosol-generating procedures, such as nebulization, for the treatment of patients with respiratory diseases with or without COVID-19. Despite the lack of evidence, there is heightened concern about the potential risk of transmission of SARS-CoV-2 in the form of aerosolized respiratory droplets during the nebulized treatment of patients with COVID-19. Consequently, the use of metered-dose inhalers (MDIs) has risen considerably as an alternative to nebulized therapy, which has led to inadequate supplies of MDIs in some parts of the United States. In this article, we review and discuss the role of nebulization in patients with SARS-CoV-2 and the treatment of noninfected patients with chronic respiratory diseases. The following two important questions are addressed: (1) should nebulized therapy be used in hospital or home settings by patients infected with SARS-CoV-2; and (2) should nebulized therapy be continued in patients already using it for chronic respiratory disease management in hospital or home settings?The reviews of this paper are available via the supplemental material section.

Keywords: COVID-19; SARS-CoV-2; chronic respiratory disease; handheld inhaler; nebulized therapy.

Figure 1.

An illustration of various possible transmission routes of respiratory infection between an infected and a susceptible individual. Both close range (i.e., conversational) airborne transmission and longer range (over several meters) transmission routes are illustrated here. The orange head color represents a source and the white head color represents a potential recipient (with the bottom right panel indicating that both heads are potential recipients via self-inoculation from contaminated surface fomite sources). Here “Expiration” also includes normal breathing exhalation, as well as coughing and/or sneezing airflows. Airborne droplets can then settle on surfaces (fomites) from where they can be touched and carried on hands leading to further self-inoculation routes of transmission. Reproduced from Tellier et al. This work is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) License. https://creativecommons.org/licenses/by/4.0/.