Inhalation therapy in children, with particular emphasis on nebulization, in the time of COVID-19 pandemic Review article

Abstract

In 2019, cases of atypical interstitial pneumonia appeared in China. The clinical course of this pneumonia was quite turbulent, clinically reminiscent of another disease of SARS viral etiology. In Europe, the first COVID-19 cases have been linked to infection from people who came from China with an asymptomatic course of the disease. We are currently observing infections not only from patients from regions with high morbidity, but also from people who have never been to these regions, and who have only experienced contact with asymptomatic or scanty symptomatic people. From the beginning of the pandemic, in children we observe a different course (milder). According to the first observations from China, severe course assessed by the depth of hypoxia was observed only in 5.6% of children, and only 0.6% developed multiorgan failure or ARDS. Is inhalation therapy safe during a pandemic? Numerous doubts arose in connection with the recommendations of government agencies and international organizations regarding inhalation steroid therapy. Warnings against the use of immunosuppressive drugs in patients infected with SARS-CoV-2 virus have been transferred to all forms of steroid therapy, including inhaled steroid therapy. Inhalation therapy is safe in patients with asthma/COPD with concomitant SARS-CoV-2 infection. GINA warns on its website not to use nebulization in patients requiring inhalation treatment. This applies to one indication for nebulization – aerosolization of a short-acting β2 mimetic to stop a fit of breathlessness. During nebulization, parts of the inhaler may be contaminated. The most common source of contamination was the infected mask as well as the nebulization chamber itself. With this in mind, the possibility of contamination of the environment should be significantly reduced during the prevailing pandemic. Necessary nebulization should be carried out only with approved medicines, and the device itself should have an anti-viral filter fitted, limiting contamination of the patient’s environment. Inhalation therapy during the COVID-19 pandemic increases the requirements for the safe conduct of inhalation therapy. By following all the principles of inhalation therapy, we can safely treat our patients.