Patients with pulmonary disease shouldn't quit aerosolized medication over COVID fears


By Linda Carroll

(Reuters Health) - COVID-19 concerns should not stop patients from using inhaled corticosteroids, a new commentary article suggests.

While patients with pulmonary diseases are at increased risk of developing COVID-19, those treatments may actually reduce the likelihood of infection and the worsening of symptoms in those already infected with the virus, a respiratory specialist advises in The Lancet Respiratory Medicine.

"Patients with pulmonary disease should continue their regular treatment plan and continue taking their prescribed medications at home," said the author of the commentary, Azuri Ari, a professor in the department of respiratory care at Texas State University, in Round Rock. "Clinicians have been concerned about the use of steroids during the pandemic and patients specifically have been afraid of inhaled medications as a potential source of virus transmission and immunosuppression."

In fact, Ari said, a recent study noted that SARS-CoV-19 infection rates appear to be lower in this population than with other chronic illnesses, and that might be because the medications are protective.

Ari suggested precautions that could help stem the spread of the disease among housemates and family members. First, that clinicians prescribe inhalers over nebulizers whenever possible.

"Exhaled air dispersion and virus transmission with inhalers are less than with jet nebulizers because inhalers have lower emitted doses and generate less aerosol mass," she writes in the commentary. "When the drug formulation is unavailable as an inhaler or patients cannot do the breathing techniques with inhalers, aerosols can be delivered with nebulizers."

The type of device used by most patients is the jet nebulizer, Ari told Reuters Health. "Previous research shows that two-thirds of the aerosols that jet nebulizers generate are released into the environment, which might increase the risk of infection for family members and other caregivers," she said, adding that a mesh nebulizer might be a better choice since fewer aerosols are released into the environment with this this type of device.

Either way, the best way to protect caregivers, family members and housemates is to nebulize away from others, Ari said.

"When a patient needs to take inhaled medications it should be done on the porch or patio or in their garage," Ari said. "That way emissions won't circulate and accumulate in the house."

If that's not possible, then the patient should isolate themselves during treatment in a room away from everyone else, Ari said. The room should be well-ventilated with open windows and a meter away from family members, she added. "Patients should cover their noses and mouths with a tissue when coughing and should discard the used tissue in a trash can in the patient's room," Ari cautioned.

Dr. Michelle Prickett agrees that patients should continue therapy whether they are infected with the coronavirus or not.

These therapies are designed to keep lungs healthy, said Dr. Prickett, an associate professor of pulmonary and critical care medicine at Northwestern University's Feinberg School of Medicine, in Chicago. And healthy lungs are less likely to become infected with SARS-CoV-2 and are more likely to do better if a patient becomes infected, she added.

"Patients staying at home (with COVID-19) should look to improve air turnover and make sure their equipment is clean so they won't be introducing the virus into the air," Dr. Prickett said. "Most physicians recommend cleaning after each treatment with soapy water and air drying."

SOURCE: The Lancet Respiratory Medicine, online June 22, 2020.

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