The outcomes and acceptance of pressurized metered‐dose inhaler bronchodilators with venturi mask modified spacer in the outpatient emergency department during the COVID‐19 pandemic

Abstract

What is known and objective Nebulizer use has been suspended in Malaysian public health facilities due to the potential to aggravate COVID‐19 nosocomial transmission. Currently, our facility uses the pressurized metered‐dose inhaler (pMDI) bronchodilator with Venturi mask modified spacer (VMMS) in patients visiting the Emergency Department (ED) for mild to moderate exacerbation of asthma and chronic obstructive pulmonary disease (COPD). We sought to assess the outcomes and acceptance of pMDI‐VMMS in the outpatient ED of a tertiary hospital in Malaysia. Methods We analysed the total visits and discharge rates during periods of using the nebulizer and current pMDI‐VMMS methods. The acceptance of pMDI‐VMMS by patients and assistant medical officers (AMOs) were assessed by questionnaire. Results and discussion We analysed 3184 ED visits and responses from 103 patients and 32 AMOs. The direct discharge rate was similar for both nebulizer (n = 2162, 92.5%) and pMDI‐VMMS method (n = 768, 90.7%) (p‐value = 0.120). Twenty‐eight patients (27.2%) favoured the pMDI‐VMMS over the nebulizer, whereas 36 patients (35.0%) had no preference for either method. Sixty‐four patients (62.1%) felt that the current pMDI‐VMMS method was better or at least as effective in relieving their symptoms as a nebulizer. The current method was favoured over the nebulizer by twenty‐seven AMOs (84.4%). Twenty‐eight (87.5%) AMOs suggested that the current method was more effective than the nebulizer. What is new and conclusion The bronchodilator delivered via pMDI‐VMMS appeared to be comparable to nebulizer in treating mild to moderate asthma and COPD exacerbations in the outpatient ED. Most patients and AMOs accepted the use of pMDI‐VMMS in the outpatient ED during the current COVID‐19 pandemic. The Venturi mask modified spacer can be a cheap and effective alternative to the commercial spacer in a resource‐limited situation.

Emerging Roles of Malaysian Pharmacists in Asthma Management Amidst the COVID-19 Pandemic: A Narrative Review

“…In various developing countries, commercial spacers with facemask are not readily accessible due to the high cost and lack of availability, particularly as the pandemic has led to a sharp increase in demand. Despite their high price, many of these therapies are not designed for re-use with other patients due to cross-infection risk ( 33 ). However, extraordinary times call for extraordinary actions.…”

“…Another modality deployed during the pandemic in place of nebulisers and commercial spacers is the use of pMDI with the Venturi mask modified spacer (VMMS). A local study on its use in the Hospital Kuala Lumpur’s outpatient emergency department found that SABA delivered through VMMS appeared be equivalent to nebulisers in terms of efficacy, was well-accepted by patients and staff members, and offered a more cost-effective alternative to commercial spacers ( 33 ). Therefore, as resource can be the limiting factors for many healthcare facilities during this difficult times, homemade spacers and VMMS serve as efficient and promising options.…”