Life threatening situation? Always call 112

Misting vs spacer

by Ulf Arndt – medical manager Leiderdorp

As long as there is still a high risk of infection with COVID-19, fogging at the out-of-hours GP service remains under discussion. Preference remains, with a view to infection prevention, but also for medical reasons, to use the spacer as much as possible!

Patients who have been triaged for the green HAP can possibly be nebulized on the green HAP, whereby the healthcare worker must (of course) wear a mouth and nose mask. Patients who have been triaged for the red HAP should preferably first be treated with an inhaler (see NHG standard COVID-19) and if that does not help, they can be nebulized with the employees wearing full PPE.

The Federation of Medical Specialists says the following about children with asthma:

In children with mild to moderate asthma exacerbations, salbutamol administration with a spacer compared to a nebulizer device shows a significantly shorter length of stay in the ED and leads to significantly fewer admissions in young children (1-60 months) and probably (trend, but not significantly) in older children as well. The spacer is also less likely to cause side effects (lower heart rate, possibly also respiratory rate, 1 study better oxygenation). There are no study results for children with life-threatening asthma.

Reasons to use an oxygen-driven nebulizer instead of the spacer are:

•            severe or life-threatening asthma

•            Persistent low oxygen saturation < 94%.

Treating children in the ER or in the hospital with a spacer instead of a nebulizer seems to be very applicable. Effectiveness of the spacers was also demonstrated for young children (< 5 years). For practice, it is recommended to repeat – adapted to the patient’s response – the medication administration with a spacer in short intervals (every 10-15 minutes). The question of whether children with low saturation benefit from an oxygen-powered nebulizer system, given the results of the Cochrane review, is the question; Duarte’s study shows better oxygenation in the group treated with a spacer. For children with life-threatening asthma, the results cannot be applied without further ado, because this group was not included in the studies

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