Covid 19 can be especially worrying for the parent and carers of Children and young people and reassuring worried parents and carers is central to this. Some parents and carers have been purchasing Nebulisers for use by their children at home in case of emergencies. They will be seeking BHR GPs to provide support and prescriptions for essentially stable children with asthma. It is completely understandable that they will be seeking to support their children and looking to you for guidance and care.
It is vital to avoid the temptation of prescribing nebules in this case without a clinical assessment of need as issuing them when not absolutely necessary is increasing risk. A very small percentage of CYP with severe and labile/brittle asthma are the only ones that might be considered suitable for home nebulisers. Such support would require clinical assessment and / or secondary care involvement.
Colleagues are reminded not to issue nebulisers without clinical assessment. This is especially important given the risk of hypoxia if a nebuliser is given in air and not O2 as per use in the Emergency Department.
"Advise patients to ensure they have a sufficient supply of their medication at home and order them in plenty of time to ensure they do not run out. Emphasise that they do not need to over order/ stock up on their inhalers and they should not share their inhalers or spacers with family / friends.
Very few people with asthma need to use a nebuliser outside of hospital and in general it should be discouraged because using salbutamol through a spacer can be as effective:
- 4-6 puffs from a salbutamol pMDI into a spacer with a patient taking 2-3 tidal breaths is the same as a 2.5mg nebule of salbutamol
- 10-12 puffs is the equivalent of a 5mg nebule of salbutamol.
Those who have been prescribed a nebuliser should continue to use it as directed. The advice from Public Health England is that nebulisation is not a VIRAL droplet generating procedure and not considered an aerosol generating procedure for COVID-19. "
Download the BTS guidance for more details.