Is it safe to use nebulizers during a global pandemic spread by respiratory aerosols?

The Sarah Bush Lincoln Health System in Mattoon, IL, was beginning to explore the switch to nebulization when the pandemic hit.

“Prior to the pandemic, we used common canisters for MDIs and also administered nebulizers,” said Lexie Caraway, MBA, RRT, RRT-NPS, RRT-ACCS, AE-C, manager of respiratory therapy. The common canister program was implemented about eight years ago as a cost-saving measure. The decision to switch to nebulizers came from a multidisciplinary team that reviewed new medications, processes, and options on the market.

COVID-19 put a swift end to those plans. “In the beginning of the pandemic, we worked with [the] pharmacy to order additional MDIs and transition all medications to non-aerosolizing medications in an effort to protect our staff,” Caraway said.

As the months wore on, however, the general feeling of the RT staff was that MDIs were not delivering enough medication to patients who needed it. “Many of our regular COPD patients were not relieved of their shortness of breath and did not have the strength and/or coordination to activate the inhalers they were receiving,” she said.

Nebulization was considered a better option for these patients, and the staff went to bat for their patients in advocating for a return to the previously decided-upon policy. By October of last year, the hospital reinstated the nebulization option.

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