Use of Nebulizers Versus Metered Dose Inhalers in Children with Asthma Exacerbation in the Pediatric Emergency Department After the Emergence of COVID-19

Abstract

Rationale: Nebulization has been identified as an aerosol-generating procedure and its use is discouraged in patients with COVID-19 symptoms. Asthma symptoms such as cough, difficulty breathing, shortness of breath, and wheezing may be difficult to discern from patients with COVID-19. Practitioners in the Pediatric Emergency Department (PED) exercise caution in treating patients with asthma and use metered dose inhalers (MDI) over nebulizers to prevent viral spread, reserving the use of nebulizers for more critically ill patients. While previous studies have shown that MDI with spacers are equally effective in treating patients with asthma when compared to nebulizers in the PED, nebulizers continue to be the preferred treatment modality. We aim to identify if the use of nebulizers vs MDIs are associated with any change in clinical outcome in pediatric patients who presented to the PED with acute asthma exacerbation before and after the emergence of COVID-19. Methods: This is a retrospective chart review from two urban public hospitals within the same city. Patients under 21 years-old with ICD-10 codes for asthma, wheezing, reactive airway disease, shortness of breath, and difficulty breathing who presented to the PED between February 1 to June 30, 2020 were identified. Patients were divided into two groups: those who presented to the PED between February 1 to 29, 2020 (Pre-COVID) and those between March 1 to June 30, 2020 (During-COVID). Patients must have documented asthma diagnosis and must have received either an MDI, nebulizer, or both treatments while in the PED. Primary outcome of the study is patient disposition after treatment. Secondary outcome includes PED length of stay, medication delivery modality (MDI vs nebulizers), symptom presentations, and return visits within 7 days. Results: 160 charts were reviewed (see table). No differences were detected in admission or 7-day PED return visit rates between the Pre-and During-COVID groups, indicating while there were increase uses of MDIs over nebulizers since the emergence of COVID-19, there were no differences in clinical outcome. Conclusions: While nebulizers have previously been the preferred medication delivery system for acute asthma patients in the PED, we did not detect differences in clinical outcomes in these pediatric patients with the increase use of MDIs over nebulizers since the emergence of COVID-19 for acute asthma treatments.