Nebulisation therapy has been frequently used for controlling acute asthma attacks, chronic obstructive pulmonary disease (COPD) exacerbations, and for home maintenance treatment for respiratory diseases like cystic fibrosis, bronchiectasis, etc. Nebulizers are useful in patients who are unable to use an inhaler (such as elderly patients) or need a large dose of an inhaled medication.
During these unprecedented times, a lot of misconceptions have arisen related to lung health and its treatment, including the role and use of nebulisation therapy. In view of this, Indian Chest Society (ICS), the apex body of pulmonologists in India, appointed a task force to gather all the updated available evidence to come out with a guidance document for physicians. The said guidance was recently made available online ahead of print. The released guidance document talks about nebulization during the pandemic, not only in the hospital but also at home. The lead and corresponding author of this clinical commentary is Dr Rajesh Swarnakar from Nagpur while Prof Dr G C Khiln from Delhi, Dr Neeraj Gupta from Ajmer and Dr IndrlHalder from Kolkata are other co-authors.
The authors clarified that nebulization is categorized as low to medium risk as far as Covid 19 spread is concerned. ICS guidelines state that the use of traditional face mask during nebulization should be avoided during the pandemic, especially while treating Covid 19 patients. Instead, jet nebulizers are recommended to be used with a mouthpiece.
The guidance document was shared recently by Dr Rajesh Swarnakar, National Secretary of ICS, in a live webinar orgzed for physicians across the country. Many doctors across India shared similar views with ICS and stated their option on recent guidance.
According to Dr VivekNangia, Principal Director & Head at Max Super Speciality Hospital, Saket, Delhi; Dr Deepak Talwar, Senior Consultant and Chairman at Metro Respiratory Center Pulmonology & Sleep Medicine and Dr S.K. Jindal, Ex-Professor & Head of Department of Pulmonary Medicine at PGI, Chandigarh, "Asthmatic patients with no symptoms/diagnosis of Covid 19 can continue with essential nebulized medications, as recommended by their physician. Standard guidelines like maintaining safe distance and washing hands must be followed."
According to Dr PrashantChajjed, Director, Lung Care and Sleep Centre, Mumbai; Dr MahavirModi, ConsultantPulmonologist, Ruby Hall Clinic and Modi Clinic, Puneand Dr S Z Jafrey, Chief Allergologist& Pulmonologist Indore Chest & Allergy Center, "Creating awareness about the safe use of nebulization therapy and imparting knowledge to empower the doctors, paramedics, caregivers, and patients to manage nebulization better has become very crucial in these times. The first step is to consult a doctor before starting nebulization therapy." On the other hand, continuing established nebulization therapy is recommended under the guidance of the regular physician.
According to Dr DJ Christopher, Chief Pulmonary Physician, Professor -Department of Pulmonary Medicine & Associate Director (HR) at Christian Medical College, Vellore, TN; Dr Rajesh V, Chief Consultant in Pulmonary Medicine at RAJAGIRI HOSPITAL, Kerala and Dr C Ravindran, Professor & Head, Dept of Pulmonary Medicine, DM Wayanad Institute of Medical Sciences, Kerala, Former Principal, Govt Medical College, Calicut, "Nebulization at home should be performed with all safety precautions such as using a clean nebulizer in a well-ventilated room and disinfecting the nebulizer after every use. It is RECOMMENDED not to share the nebulizer between family members. To prevent the spread of infection, every nebulizer should be a single person use nebulizer. A patient can also opt for a disposable nebulizer accessory. Cleng and disinfection of nebulizer pre and post nebulization is a must."
According to Dr Ravindra Mehta, Chief of Critical Care, Consultant Pulmonologist & Sleep Medicine Specialist, Apollo Hospitals Jayanagar, Bangalore, "COVID times have led to re-evaluation of many essential practices. In the Respiratory arena, the initial fear of aerosols needs to be looked at again so as to not deprive people of essential aspects such as nebulization. This is especially true when the benefit outweighs the risk." Additionally, when COVID prevalence diminishes in the community, these practices can be done similar to pre-COVID times. In the winter period, appropriately done nebulization is an invaluable tool to prevent worsening, keep patients at home and avoid hospitalization.
Nebulization is a safe therapy provided it is performed with proper precautions. This view has also been attested by international authorities like the National Institute for Health and Care Excellence (NICE), UK; International Society of Aerosols in Medicine (ISAM), US and British Thoracic Society (BTS), UK
The above content is contributed by the Indian Chest Society's guidance for nebulization during the COVID-19 pandemic Rajesh Swarnakar, Neeraj M Gupta, IndrlHalder, Gopi C Khil.
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( With inputs from ANI )
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