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Wongsurakiat P, Rattanawongpaibul A, Limsukon A, Chiewchalermsri C, Wiwatcharagoses K, Kornthatchapong K, Saiphoklang N, Sanguanwit P, Domthong P, Kawamatawong T, Sewatanon T, Reechaipichitkul W, Maneechotesuwan K. Expert panel consensus recommendations on the utilization of nebulized budesonide for managing asthma and COPD in both stable and exacerbation stages in Thailand. J Asthma 2024:1-16. [PMID: 38527278 DOI: 10.1080/02770903.2024.2334897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/20/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVE This study investigated the utilization of nebulized budesonide for acute asthma and COPD exacerbations as well as for maintenance therapy in adults. DATA SOURCES We conducted a search on PubMed for nebulized budesonide treatment. SELECTED STUDIES Selecting all English-language papers that utilize Mesh phrases "asthma," "COPD," "budesonide," "nebulized," "adult," "exacerbation," and "maintenance" without temporal restrictions, and narrowing down to clinical research such as RCTs, observational studies, and real-world studies. RESULTS Analysis of 25 studies was conducted to assess the effectiveness of nebulized budesonide in asthma (n = 10) and COPD (n = 15). The panel in Thailand recommended incorporating nebulized budesonide as an additional or alternative treatment option to the standard of care and systemic corticosteroids (SCS) based on the findings. CONCLUSION Nebulized budesonide is effective and well-tolerated in treating asthma and COPD, with less systemic adverse effects compared to systemic corticosteroids. High-dose nebulized budesonide can enhance clinical outcomes for severe and mild exacerbations with slow systemic corticosteroid response. Nebulized budesonide can substitute systemic corticosteroids in some situations.
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Affiliation(s)
- Phunsup Wongsurakiat
- Division of Respiratory Diseases and Tuberculosis, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Atikun Limsukon
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chirawat Chiewchalermsri
- Department of Internal Medicine, Panyananthaphikkhu Chonprathan Medical Center Srinakharinwirot University, Nonthaburi, Thailand
| | - Kittiyaporn Wiwatcharagoses
- Department of Emergency Medicine, Faculty of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | | | - Narongkorn Saiphoklang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Pitsucha Sanguanwit
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pornanan Domthong
- Division of Pulmonary and Critical Care Division, Department of Internal Medicine, Khon Kaen Hospital, Khon Kaen, Thailand
| | - Theerasuk Kawamatawong
- Associate Professor of Medicine, General Secretariate, Thai Asthma Council (TAC), Bangkok, Thailand
| | - Tirachat Sewatanon
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Wipa Reechaipichitkul
- Division of Pulmonary and Critical Care Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kittipong Maneechotesuwan
- Division of Respiratory Diseases and Tuberculosis, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Dhanak M, Verma S, Hughes PG, Ching AL, Lo A, Clay C, McKinney A, Frankenfield J. The Laboratory Characterization of Fugitive Aerosol Emissions From a Standard Jet Nebulizer With and Without a Filtered Mouthpiece. Cureus 2023; 15:e50611. [PMID: 38226095 PMCID: PMC10788659 DOI: 10.7759/cureus.50611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024] Open
Abstract
Background and objective The risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission from patients with coronavirus disease 2019 (COVID-19) during nebulization is unclear. In this study, we aimed to address this issue. Methods Fugitive emissions of aerosolized saline during nebulization were observed using a standard jet nebulizer fitted with unfiltered and filtered mouthpieces connected via a mannequin to a breathing simulator. Fugitive emissions were observed by using a laser sheet and captured on high-definition video, and they were measured by using optical particle counters positioned where a potential caregiver may be administering nebulization and three other locations in the sagittal plane at various distances downstream of the mannequin. Results The use of a standard unfiltered mouthpiece resulted in significant emission of fugitive aerosols ahead of and above the mannequin (spread over 2 m in front). A mouthpiece with a filter-adaptor effectively suppressed the emissions, with only minor leakage from the nebulizer cup. Particle count measurements supported the visual observations, providing total particle count levels and aerosol concentration levels at the measurement locations. The levels decayed slowly with downstream distance. Conclusions The visualization described above captured the dispersion of emitted aerosols in the plane of the laser sheet, aligned with the sagittal plane. The particle count measurements provided temporal and spatial distributions of the aerosol concentration levels over the time and locations considered. However, the exhaled air and aerosolized droplets spread three-dimensionally in front of and above the mannequin. The results visually highlight the effectiveness of using a filtered mouthpiece in suppressing the fugitive aerosols and identify an approach for limiting the occupational exposure of healthcare workers to these emissions while administering nebulized therapies.
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Affiliation(s)
- Manhar Dhanak
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, USA
| | - Siddhartha Verma
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, USA
| | - Patrick G Hughes
- Emergency Medicine, Florida Atlantic University, Boca Raton, USA
| | - Ai Ling Ching
- Medical Affairs, Theravance Biopharma US, Inc., South San Francisco, USA
| | - Arthur Lo
- Medical Affairs, Theravance Biopharma US, Inc., South San Francisco, USA
| | - Candice Clay
- Medical Affairs, Theravance Biopharma US, Inc., South San Francisco, USA
| | - Adriana McKinney
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, USA
| | - John Frankenfield
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, USA
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Thibon C, Vecellio L, Belkhir L, Dubus JC, Robert A, Kabamba B, Reychler G. There Is a Risk of Spread During a Nebulization Session in a Patient with COVID-19. J Aerosol Med Pulm Drug Deliv 2023; 36:268-274. [PMID: 37610849 DOI: 10.1089/jamp.2023.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
Introduction: A hypothetical risk of SARS-CoV-2 airborne transmission through nebulization was suggested based on a potential environmental contamination by the fugitive aerosol emitted in the environment during the procedure. The aim of this study was to verify this risk from the fugitive aerosol emitted by COVID-19 patients during one nebulization session. Methods: In this cohort study, COVID-19 patients treated with nebulization were recruited at their admission to the hospital. Patients had to perform a nebulization session while a BioSampler® and a pump were used to vacuum the fugitive aerosol and collect it for SARS-CoV-2 RNA detection. Results: Ten consecutive patients hospitalized with COVID-19 were recruited. The median viral load was 6.5 × 106 copies/mL. Two out of the 10 samples from the fugitive aerosol collected were positive to SARS-CoV-2. Conclusion: The risk of fugitive aerosol contamination with SARS-CoV-2 during nebulization has now been verified.
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Affiliation(s)
- Christophe Thibon
- Secteur de Kinésithérapie et Ergothérapie, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
- Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Laurent Vecellio
- PST A, Université de Tours, Tours, France
- Group Aerosoltherapy GAT of the French Language Respiratory Society-Société de Pneumologie de Langue Française SPLF, Paris, France
| | - Leila Belkhir
- Department of Internal Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Jean-Christophe Dubus
- Group Aerosoltherapy GAT of the French Language Respiratory Society-Société de Pneumologie de Langue Française SPLF, Paris, France
- Unité de Pneumologie Pédiatrique, Centre Hospitalo-Universitaire (CHU) Timone-Enfants, Marseille, France
- Aix Marseille Université, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Annie Robert
- Pole épidémiologie et biostatistique, Institut de recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium
| | - Benoît Kabamba
- Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
- Department of Microbiology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Gregory Reychler
- Secteur de Kinésithérapie et Ergothérapie, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
- Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Group Aerosoltherapy GAT of the French Language Respiratory Society-Société de Pneumologie de Langue Française SPLF, Paris, France
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