Acute asthma management during SARS-CoV2-pandemic 2020
Publication in refereed journal


Times Cited
Altmetrics Information
.

Other information
AbstractBackground
The current COVID-19 pandemic has changed many medical practices in order to provide additional protection to both our patients and healthcare providers. In many cases this includes seeing patients through electronic means such as telehealth or telephone rather than seeing them in person. Asthma exacerbations cannot always be treated in this way.

Problem
Current emergency unit asthma guidelines recommend bronchodilators be administered by metered dose inhaler (MDI) and spacer for mild-moderate asthma and include it as a choice even in severe asthma, but many emergency units continue to prefer nebulised therapy for patients who urgently require beta-agonists. The utilization of nebulised therapy potentially increases the risk of aerosolization of the coronavirus. Since nosocomial transmission of respiratory pathogens is a major threat in the context of the SARS-CoV-2 pandemic, use of nebulised therapy is of even greater concern due to the potential increased risk of infection spread to nearby patients and healthcare workers.

Practical implications
We propose a risk stratification plan that aims to avoid nebulised therapy, when possible, by providing an algorithm to help better delineate those who require nebulised therapy. Protocols that include strategies to allow flexibility in using MDIs rather than nebulisers in all but the most severe patients should help mitigate this risk of aerosolised infection transmission to patients and health care providers. Furthermore, expedient treatment of patients with high dose MDI therapy augmented with more rapid initiation of systemic therapy may help ensure patients are less likely to deteriorate to the stage where nebulisers are required.
Acceptance Date07/05/2020
All Author(s) ListMichael Levin, Ignacio J. Ansotegui, Jonathan Bernstein, Yoon-Seok Chang, Manana Chikhladze, Motohiro Ebisawa, Alessandro Fiocchi, Enrico Heffler, Bryan Martin, Mario Morais-Almeida, Nikolaos G. Papadopoulos, David Peden, Gary W. K. Wong
Journal nameWorld Allergy Organization Journal
Year2020
Month5
Volume Number13
Issue Number5
PublisherElsevier
Article number100125
ISSN1939-4551
LanguagesEnglish-United States

Last updated on 2021-27-09 at 05:40