To Enrich Lives

Courtesy of the American Association for Respiratory Care – Oct 8, 2020

COVID-19 has taken the world by storm and it doesn’t seem to be leaving anytime soon. So, as  the coming months bring winter and cool crisp weather, you as a respiratory therapist may begin to worry about your patients living with asthma. With no vaccine for COVID-19 and asthma triggering weather on the horizon, it is important to make sure your patients are extra careful this winter season.

That’s why we asked for some help from AARC member Joyce Baker, RRT, RRT-NPS, AE-C, who currently serves as the asthma clinical program coordinator for Children’s Hospital Colorado. The following is a list of frequently asked questions regarding asthma and COVID-19 compiled by Joyce. Read them over and share them with your asthma patients—

Asthma – COVID-19 FAQ

Q: Is asthma “at risk” for COVID-19?

A: People with asthma are more likely to be hospitalized than someone without asthma, mostly because viral illnesses can trigger asthma exacerbations. We cannot say whether asthma attacks from COVID-19 are any different than asthma attacks from any other viral infection. Good ways to decrease risk of an asthma attack from a viral illness is to:

• Take daily controller medications.
• Take inhaled corticosteroid medication, which MAY decrease susceptibility of infection
• Make sure asthma medications are refilled.
• Call your health care provider if the quick reliever does not resolve asthma symptoms.

Q: Should a child with asthma return to in person classrooms?

A: The American Academy of Pediatrics (AAP) released guidelines saying that it “strongly advocates” the goal of having students “physically present in school.” The AAP based their recommendations on the following emerging evidence:

• Children are much less likely than adults to get very sick from the virus. Children 10 years old and younger are also less likely to transmit the virus to others.
• No more risk than flu season.
• School closures resulted in significant ‘harms’ to children. These harms included a lack of socialization, learning deficits, a decreased ability for schools to monitor problems like depression and abuse, and less access for students to physical activity and to affordable or free food.
• If a family chooses not to have a child return to in person classroom it is important to respect this decision.

Q: Are there different precautions for a person with asthma who is returning to in person classroom or work?

A: No, people with asthma can return to an in-person classroom or work. All children two and older should wear a mask to prevent the spread, there is no exemption for asthma. Continue Reading…

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Courtesy of Minnesota Department of Health

The COVID-19 pandemic has resulted in several changes to the delivery of health care. One area that has been impacted is in the use of nebulizers and peak-flow meters in various schools and other educational venues, including community-based settings such as child care or head Start programs.

Prior to COVID-19, school and child care staff could administer a nebulizer treatment with minimal training in the procedure and within almost any room environment. This is no longer the current recommendation. The Centers for Disease Control and Prevention (CDC) has issued guidance regarding children with asthma or other chronic respiratory conditions that require treatment.

CDC guidance states:

• Symptoms of COVID-19 and asthma may overlap, including cough and shortness of breath. Children who are symptomatic must not attend school until seen by a healthcare provider.
• During COVID-19, asthma treatment with an inhaler and spacer are preferred over nebulizer treatments whenever possible. Asthma inhalers are not considered an aerosol-generating procedure.
• Due to limited data, it is unknown whether aerosols generated by nebulizer treatments are infectious. Therefore, nebulizer treatments should be reserved for those children who cannot use or do not have access to an inhaler.
• Use of a peak-flow meter is not considered an aerosol-generating procedure, based on limited data. However, use of a peak-flow meter can trigger a cough.
• Those staff who administer either nebulizer treatments or peak-flow meters should wear personal protective equipment (PPE), which includes medical or surgical face mask, eye protection, and gloves.
• The nebulization should be administered in a room that is separate from other care delivery and can be cleaned and disinfected after the procedure.
• The only people present in the room during a nebulizer treatment or use of a peak-flow meter should be the child receiving the treatment/test, and the staff member administering the treatment/test.
• This CDC guidance brings challenges to administering nebulized treatments in school and community settings.

The challenges include:

• Obtaining and educating staff on proper use, donning and doffing of PPE.
• Ongoing community shortages of PPE.
• Identifying a space to accommodate the administration of nebulizer treatments.

In consideration of the CDC recommendations, the Minnesota Department of Health is encouraging prescribing providers to evaluate the opportunity to transition children from a nebulizer to an inhaler with spacer for use in schools and community settings during the COVID-19 pandemic. This school will work with students and families on making this change from nebulizer to using an inhaler during the school day.

If you have any additional questions, please contact the Minnesota Department of health at health.schoolscovid19@state.mn.us

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Courtesy of HME News:

by Liz Beaulieu – Friday, August 21, 2020

WASHINGTON – Complex rehab stakeholders have taken steps to advance key initiatives related to power seat elevation and power standing systems, and telehealth and remote services.

Stakeholders, led by the ITEM Coalition, have created four work groups (clinical, reimbursement/technology, legal and congressional/advocacy) to work on filing a request for reconsideration of the Medicare NCD for power seat elevation and power standing systems. They’re almost ready to submit that request, said Don Clayback during a recent webcast.

“We’ve also had a preliminary call with CMS officials,” said Clayback, executive director of NCART. “They asked some questions, (so) there’s a couple of additional pieces of information we’re going to be adding. But it was a positive call. They encouraged us to move forward on the path we’re on.

The timeline for CMS processing these requests is “a little bit flexible,” but it will be good for stakeholders to have this first step behind them, Clayback said.

Once the request is complete, stakeholders will share it publicly, he said.

“The submission itself is 60 pages and includes exhibits, libraries of articles, and evidence and studies that validate the medical side of power seat elevation and power standing,” Clayback said.

Stakeholders have also created the CRT Remote Services Consortium to establish permanent policies within federal, state and commercial programs around telehealth for physicians and clinicians, and remote services for providers.

“(We want) to make sure remote services are available as an option,” Clayback said. “There’s nothing that’s going to require it, but they have a place. We’re all convinced from an outcomes perspective, a timely access perspective and a comprehensive evaluation perspective that having remote services and telehealth available really improves the experience.”

The consortium represents a cross section of providers, clinicians, consumers and others; and includes two subgroups, one related to policy and one to advocacy.

“There’s a lot of work (to do), but the good news is, we have a consortium that will provide a good umbrella for everyone to work under,” Clayback said.