Texas State expert sheds light on aerosol medicine for COVID-19 patients

Dr. Arzu Ari, a physical therapist and respiratory therapist with 25 years of experience, joined the faculty of the Texas State Department of Respiratory Care in 2017.

Dr. Arzu Ari is a physical therapist and a respiratory therapist with 25 years of experience as a manager, clinician, educator and researcher. Since 2000, her research has concentrated on aerosol medicine and she has been recognized as an outstanding researcher/professor in the field.

Most recently, her research paper titled “Practical strategies for a safe and effective delivery of aerosolized medications to patients with COVID-19” was published in the Respiratory Medicine Journal. Delivering aerosolized medications to patients with COVID-19 can aggravate the spread of the novel coronavirus. This has been a real concern for caregivers and healthcare professionals who are susceptible to unintended inhalation of fugitive emissions during therapy. Due to a scarcity of information in this area of clinical practice, Dr. Ari published the paper to explain how to deliver aerosolized medications to mild-, sub-intensive, and intensive-care patients with COVID-19 and how to protect staff from exposure to exhaled droplets during aerosol therapy.
 

Q+A with Dr. Arzu Ari

Can you describe how your research applies to the fight against COVID-19?

Aerosol therapy is a medical treatment used to deliver aerosolized medications to patients’ lungs with inhalers or nebulizers to treat pulmonary diseases. My work in aerosol medicine helps clinicians understand how to administer aerosolized medications to mild-, sub-intensive, and intensive-care patients with COVID-19.

What can you say to the general public about drug delivery to patients with COVID-19?

Aerosol therapy is the cornerstone of disease management in asthma, chronic obstructive pulmonary disease (COPD) or cystic fibrosis. If they have a pulmonary disease and are prescribed inhaled medications by their doctors, they should keep using their inhaled medications to achieve optimal disease management. Therefore, patient’s compliance with prescribed aerosol therapy is vital in this pandemic.  

The upside of this pandemic is that we learned the importance of personal protection and infection control. Wearing personal protective equipment, practicing healthy hand hygiene and cleaning/disinfecting surfaces and frequently touched items are extremely important. Following social distancing guidelines is essential during the pandemic. Many suspected patients with COVID-19 are recommended to stay at home to minimize physical contact. 

Healthcare providers have already started utilizing telehealth to evaluate patients at home and minimize the utilization of healthcare facilities by them. Through telehealth, patients can have a virtual visit with their doctors that will allow them to safely and conveniently see their doctors using a smart phone or computer with internet connection.

There is so much negative information about COVID-19 that can make patients concerned. Although negativity is infectious, patients should remember that the choice does not belong to pessimism and scare; it belongs to them. I am an optimist and believe that there is always light somewhere. I suggest finding the good in what we have, enjoying good things in our lives and being thankful for everything we have. This will give us strength that we need until we see the light at the end of the tunnel. 

What should clinicians know about this method of aerosol delivery? 

Here are my recommendations:

• It is crucial to avoid unnecessary aerosol therapy to patients with COVID-19.
• Inhalers should be preferred over nebulizers in mild-coronavirus infected patients who can perform specific breathing techniques.
• If aerosolized medications are delivered via high flow nasal cannula, a surgical mask should be placed on the patient’s face.
• Mesh nebulizers should be preferred for aerosol delivery and placed before the humidifier in ventilator-dependent patients with COVID-19. 
• Attaching a HEPA filter to the expiratory limb of ventilator circuits will decrease secondhand aerosol exposure.
• Clinicians should wear personal protective equipment and deliver aerosolized medications in negative pressure rooms.

Will you share some final thoughts on the current pandemic situation?

As Marie Curie said, “nothing in life is to be feared, it is only to be understood. Now is the time to understand more so that we may fear less.” We are strong when we know our fears and limitations. It is time to start thinking about what is necessary and doing what is possible using a proactive and comprehensive approach to aerosol drug delivery for patients with COVID-19. 

Respiratory therapists have enormous experience in aerosol therapy and the foundation of delivering aerosolized medications to coronavirus infected patients should be grounded in their experience and current guidelines on COVID-19.

About Dr. Ari:

Dr. Arzu Ari joined the faculty of the Texas State Department of Respiratory Care in 2017. Among her many awards, Ari’s work has received the Monaghan/Trudell Fellowship for Aerosol Technique Development from the American Respiratory Care Foundation three times in the past 10 years. She also received the Mitchell Baran Achievement Award for Clinical Excellence in Aerosol and Airway Clearance Therapies in 2018 and became a Fellow of the American College of Chest Physicians this year.