Nebulization is safe, say experts

Mumbai (Maharashtra) [India], January 30 (ANI/Mediawire): 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 Khilnani from Delhi, Dr Neeraj Gupta from Ajmer and Dr Indranil Halder from Kolkata are other co-authors.
Nebulization 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.
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 organized for physicians across the country. Many doctors across India shared the similar views with ICS and stated their option on recent guidance.

Dr Swarnakar 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.
According to Dr Rajesh Chandra Mishra, Honorary Consultant Intensivist & Internist, Ahmedabad, General Secretary ISCCM (2019-2020) stated, “Asthmatic patients with no symptoms or no confirmed 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. A fresh mask, mouthpiece and tubing should be preferred for each nebulization treatment.”
Dr Mishra, further added, “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.”
“COVID times have led to re-evaluation of many essential practises. 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.” Added Dr Mishra.
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 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 to NOT 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. Cleaning and disinfection of nebulizer pre and post nebulization is a must!
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