Acute asthma management during SARS-CoV2-pandemic 2020: World Allergy Organization Journal

M. Levin, I.J. Ansotegui, J. Bernstein, Y.-S. Chang, M. Chikhladze, M. Ebisawa, A. Fiocchi, E. Heffler, B. Martin, M. Morais-Almeida, N.G. Papadopoulos, D. Peden, G.W.K. Wong

Research output: Contribution to journalArticlepeer-review


Background: The current COVID-19 pandemic has changed many medical practices in order to provide additional protection to both our patients and healthcare providers. In many cases this includes seeing patients through electronic means such as telehealth or telephone rather than seeing them in person. Asthma exacerbations cannot always be treated in this way. Problem: Current emergency unit asthma guidelines recommend bronchodilators be administered by metered dose inhaler (MDI) and spacer for mild-moderate asthma and include it as a choice even in severe asthma, but many emergency units continue to prefer nebulised therapy for patients who urgently require beta-agonists. The utilization of nebulised therapy potentially increases the risk of aerosolization of the coronavirus. Since nosocomial transmission of respiratory pathogens is a major threat in the context of the SARS-CoV-2 pandemic, use of nebulised therapy is of even greater concern due to the potential increased risk of infection spread to nearby patients and healthcare workers. Practical implications: We propose a risk stratification plan that aims to avoid nebulised therapy, when possible, by providing an algorithm to help better delineate those who require nebulised therapy. Protocols that include strategies to allow flexibility in using MDIs rather than nebulisers in all but the most severe patients should help mitigate this risk of aerosolised infection transmission to patients and health care providers. Furthermore, expedient treatment of patients with high dose MDI therapy augmented with more rapid initiation of systemic therapy may help ensure patients are less likely to deteriorate to the stage where nebulisers are required. © 2020 The Author(s)
Original languageEnglish
JournalWorld Allergy Organ. J.
Issue number5
Publication statusPublished - 2020


  • Asthma
  • COVID-19
  • Exacerbation
  • Infectious risk
  • Inhalers
  • Protocol
  • Treatment
  • aminophylline
  • beta adrenergic receptor stimulating agent
  • bronchodilating agent
  • corticosteroid
  • ipratropium bromide
  • magnesium sulfate
  • muscarinic agent
  • salbutamol
  • aerosol
  • asthma
  • clinical protocol
  • coronavirus disease 2019
  • disease severity
  • early intervention
  • emergency ward
  • fatigue
  • headache
  • health care personnel
  • hospital infection
  • human
  • hypotension
  • medical decision making
  • nausea
  • pandemic
  • practice guideline
  • priority journal
  • Review
  • risk assessment
  • risk management
  • Severe acute respiratory syndrome coronavirus 2
  • side effect
  • virus transmission


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