Asthma — Changes in the setting of COVID-19 — Clinical Pathway: Emergency, Inpatient and ICU

ED Asthma Pathway Changes in the setting of COVID-19

With emerging community transmission of COVID-19, preventing aerosolization of infectious particles is an important way of keeping patients, families and staff safe. As a result, we are immediately rolling out changes to our asthma pathway to limit the use of nebulized medications. The specific changes to our pathway are as follows:

ED Asthma Mild, Moderate Pathways

No changes, continue use of albuterol via MDI with spacer.

ED Asthma Severe Pathway

  1. Start with q20 minute weight-based albuterol (4,6,8 puffs weight-based via MDI with spacer) x 3 total treatments prn moderate-severe respiratory distress.
  2. Ipratropium MDI can be given at 4 puffs (5-10 kg), 6 puffs (> 10-20 kg), 8 puffs (> 20 kg) during the 1st hour.
  3. Consider early use of IV Magnesium.
  4. Hold initiation of continuous albuterol until after 2nd UniNeb administered.

Special circumstances

Patients on HFNC or NIPPV

  • Patients on NIPPV produce aerosolized particles. Give nebulized albuterol and/or ipratropium as needed using high-efficiency nebulizer order in ED Asthma Order set under Severe without Response.
  • Refer to guidelines for aerosol-generating procedures.
  • If using NIPPV, recommend use of full face mask with V500 or Hamilton.
  • Consider early endotracheal intubation if not improving in disease course, review with ICU team as needed.