German Society for Pneumology
The novel coronavirus keeps throwing the world curve balls, raising many questions, including the issue of the treatment of chronic respiratory diseases. One thing we do know is that: according to a NICE statement, also during the coronavirus pandemic, nebuliser therapy is a safe option2, ensuring your patients receive a reliable and effective therapy irrespective of their age and medical condition3.
Transmission via small bioaerosols exhaled from the lungs is now recognised as an important route of transmission.4 It is important to differentiate bioaerosols – released by the patient – and medical aerosol generated by a nebuliser. As in the ISAM COVID-19 guidance paper5 is stated: “Medical aerosols from nebulization derive from a nonpatient source (the fluid in the nebulizer chamber) and have not been shown to carry patient-derived viral particles. Concerns of medical aerosol becoming contaminated in the lungs before exhalation are not supported by evidence. Consequently, when a droplet in the aerosol coalesces with a contaminated mucous membrane, it will cease to be airborne and, therefore, will no longer be part of an aerosol. In fact, aerosol administration has been reported to reduce generation of bioaerosols6.”
Dr. Thomas Voshaar; aerosol expert and medical advisor to the German Ministry of Health
“Patients with chronic respiratory diseases should continue their treatment as usual. This also applies if the treatment plan includes corticosteroids. […]. If they contract COVID-19 on top of uncontrolled asthma, the situation will be much more critical than if they continue corticosteroid inhalation while taking careful precautions to avoid becoming infected” states Prof. Dr. Wolfgang Kamin in an interview with PARI.
This makes it all the more important that respiratory patients have a well-managed treatment regimen that they adhere to. Adherence can be significantly affected by usage errors, as both a lack of effect and local side effects can lead to patients discontinuing their therapy of their own accord.5 User error is greatly reduced when patients use nebulisers for their therapy, as they only require simple, tidal breathing.
Furthermore, secretolysis by inhaling hypertonic saline, which is important for many respiratory patients, can only be achieved by using a nebuliser. Nebulisation is an important component of the treatment of patients with cystic fibrosis, for instance. As Prof. Dr. Rainald Fischer states in an interview with PARI: “Respiratory patients who use a nebuliser should continue to do so.”
Köhler 2007 - formerly president of the German Society for Pneumology (2005-2007)
Find out more about how inhalation with isotonic saline solutions can help keep viral infections at bay. Inhalation with saline solution is generally effective, irrespective of the type of disease pathogen.
PARI nebulisers can easily be sterilised in boiling water, leaving them hygienically safe, without the need for chemical disinfectants.
Brigitte Schmailzl, physiotherapist for the German bobsleigh team and for the Reference Centre for Respiratory Therapy in Sport talks about how inhalation therapy is an important factor in virus protection for everybody.
1 Pfeifer M et al.: Position Paper for the State-of-the-Art Application of Respiratory Support in Patients with COVID-19 (https://pneumologie.de/fileadmin/user_upload/COVID-19/20200417_DGP_Pp_Covid-19_Respiratory_Support_engl.pdf)
3 Voshaar T et al: Empfehlungen für die Auswahl von Inhalationssystemen zur Medikamentenverabreichung. Pneumologie 2001; 55(12): 579-86
5 Fink et al: Reducing Aerosol-Related Risk of Transmission in the Era of COVID-19: An Interim Guidance Endorsed by the International Society of Aerosols in Medicine. Journal of Medicine and Pulmonary Drug Delivery, Vo.33, No. 0, 2020
6 Edwards, D. A. Proc Natl Acad Sci U S A. 2004; vol 101, no 50: 17383 -88
7 Rootmensen GN et al: Predictors of incorrect inhalation technique in patients with asthma or COPD: a study using a validated videotaped scoring method. J Aerosol Med Pulm Drug Deliv 2010; 23(5): 323-8