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Aerosol Generation and Mitigation During Methacholine Bronchoprovocation Testing: Infection Control Implications in the Era of COVID-19.

Authors :
Subat, Yosuf W.
Hainy, Matthew E.
Torgerud, Keith D.
Sajgalik, Pavol
Guntupalli, Siva Kamal
Johnson, Bruce D.
Kim Chul-Ho
G. Lim, Kaiser
Helgeson, Scott A.
Scanlon, Paul D.
Niven, Alexander S.
Source :
Respiratory Care; Dec2021, Vol. 66 Issue 12, p1858-1865, 8p
Publication Year :
2021

Abstract

BACKGROUND: Methacholine bronchoprovocation or challenge testing (MCT) is commonly performed to assess airway hyper-responsiveness in the setting of suspected asthma. Nebulization is an aerosol-generating procedure, but little is known about the risks of MCT in the context of the ongoing coronavirus disease 2019 (COVID-19) pandemic. We aimed to quantify and characterize aerosol generation during MCT by using different delivery methods and to assess the impact of adding a viral filter. METHODS: Seven healthy subjects performed simulated MCT in a near particle-free laboratory space with 4 different nebulizers and with a dosimeter. Two devices continuously sampled the ambient air during the procedure, which detected ultrafine particles, from 0.02--1 μm, and particles of sizes 0.3, 0.5, 1.0, 2.0, 5.0, and 10 µm, respectively. Particle generation was compared among all the devices, with and without viral filter placement. RESULTS: Ultrafine-particle generation during simulated MCT was significant across all the devices. Ultrafine-particle (0.02--1 μm) concentrations decreased 77%--91% with the addition of a viral filter and varied significantly between unfiltered (P < .001) and filtered devices (P < .001). Ultrafine-particle generation was lowest when using the dosimeter with filtered Hudson nebulizer (1,258 ± 1,644 particle/mL). Ultrafine-particle concentrations with the filtered nebulizer devices using a compressor were higher than particle concentrations detected when using the dosimeter: Monaghan (3,472 ± 1,794 particles/mL), PARI (4,403 ± 2,948), Hudson (6,320 ± 1,787) and AirLife (9,523 ± 5,098). CONCLUSIONS: The high particle concentrations generated during MCT pose significant infection control concerns during the COVID-19 pandemic. Particle generation during MCT was significantly reduced by using breath-actuated delivery and a viral filter, which offers an effective mitigation strategy. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
00201324
Volume :
66
Issue :
12
Database :
Supplemental Index
Journal :
Respiratory Care
Publication Type :
Academic Journal
Accession number :
153765110
Full Text :
https://doi.org/10.4187/respcare.09236