{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T10:29:37Z","timestamp":1777458577468,"version":"3.51.4"},"reference-count":25,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2024,7,22]],"date-time":"2024-07-22T00:00:00Z","timestamp":1721606400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2024,7,22]],"date-time":"2024-07-22T00:00:00Z","timestamp":1721606400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100013993","name":"Theravance Biopharma US, Inc.","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100013993","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Infection Prevention"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Conflicting guidance exists regarding the characterization of nebulization as an aerosol-generating procedure and subsequent risk of transmission of SARS-CoV-2 to healthcare workers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim\/Objective<\/jats:title>\n                    <jats:p>This study sought to address whether SARS-CoV-2 viral load distribution was impacted by bronchodilator delivery via nebulizer versus metered-dose inhaler (MDI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adults infected with COVID-19 were enrolled and received a single dose of albuterol sulfate nebulized solution (2.5\u00a0mg\/3\u00a0mL via breath-actuated nebulizer with filtered mouthpiece) or albuterol sulfate hydrofluoroalkane inhalation aerosol (90\u00a0\u00b5g\/actuation; two puffs via MDI with spacer) in a randomized crossover sequence. Air and surfaces were sampled at predefined locations within patients\u2019 hospital rooms to assess SARS-CoV-2 dispersion over three periods (baseline, MDI, and nebulizer).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings\/Results<\/jats:title>\n                    <jats:p>\n                      Eleven patients received crossover therapy. Six patients had detectable SARS-CoV-2 RNA during one treatment period (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 3 each for MDI and nebulizer) and one during both treatment periods. No viral RNA was found in the rooms of four (36.4%) patients. Overall, few environmental samples (17\/397; 4.3%) contained detectable viral RNA, with no meaningful differences in positivity rate across periods; RNA genome copy numbers were low in positive samples. No correlation between dispersion and patient clinical status or environmental parameters was observed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>In this first prospective trial evaluating viral load distribution following use of nebulizer versus MDI in hospitalized patients with COVID-19, low environmental contamination was found regardless of administration method. Findings support the use of either device when needed to treat patients with COVID-19.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17571774241266420","type":"journal-article","created":{"date-parts":[[2024,7,22]],"date-time":"2024-07-22T10:10:44Z","timestamp":1721643044000},"page":"19-25","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of nebulization versus metered-dose inhaler utilization on viral particle dispersion in patients with COVID-19"],"prefix":"10.1177","volume":"26","author":[{"given":"Brian M","family":"Clemency","sequence":"first","affiliation":[{"name":"University of Buffalo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Candice","family":"Clay","sequence":"additional","affiliation":[{"name":"Theravance Biopharma US, Inc."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5176-3855","authenticated-orcid":false,"given":"Renoj","family":"Varughese","sequence":"additional","affiliation":[{"name":"University of Buffalo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carli","family":"Kennedy","sequence":"additional","affiliation":[{"name":"University of Kansas Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wayne","family":"Yates","sequence":"additional","affiliation":[{"name":"Theravance Biopharma US, Inc."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asma","family":"Lat","sequence":"additional","affiliation":[{"name":"Dermavant Sciences, Inc."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ai","family":"Ling Ching","sequence":"additional","affiliation":[{"name":"Erasca, Inc."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Doug","family":"Clark","sequence":"additional","affiliation":[{"name":"Aligos Therapeutics, Inc."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Lewin","sequence":"additional","affiliation":[{"name":"LLC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xianyi","family":"Chen","sequence":"additional","affiliation":[{"name":"Theravance Biopharma US, Inc."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6328-8994","authenticated-orcid":false,"given":"Mario","family":"Castro","sequence":"additional","affiliation":[{"name":"University of Kansas Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,7,22]]},"reference":[{"key":"e_1_3_6_2_1","unstructured":"American Association for Respiratory Care (2021) Aerosol generating procedures: relevance and pragmatic suggestions. Available at: https:\/\/archive2023.aarc.org\/an21-aerosol-generating-procedures-relevance-and-pragmatic-suggestions\/ (accessed 17 July 2024)."},{"key":"e_1_3_6_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11357-022-00561-z"},{"key":"e_1_3_6_4_1","unstructured":"Centers for Disease Control and Prevention (2022a) Clinical questions about COVID-19: questions and answers. Available at: https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/hcp\/faq.html (accessed 8 August 2022)."},{"key":"e_1_3_6_5_1","unstructured":"Centers for Disease Control and Prevention (2022b) SARS-CoV-2 variant classifications and definitions. Available at: https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/variants\/variant-classifications.html (accessed 8 September 2022)."},{"key":"e_1_3_6_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/bph.15197"},{"key":"e_1_3_6_7_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202004-1263PP"},{"key":"e_1_3_6_8_1","doi-asserted-by":"publisher","DOI":"10.1089\/jamp.2020.1615"},{"issue":"3","key":"e_1_3_6_9_1","first-page":"155","article-title":"Risk of transmitting coronavirus disease 2019 during nebulizer treatment: a systematic review","volume":"34","author":"Goldstein KM","year":"2021","unstructured":"Goldstein KM, Ghadimi K, Mystakelis H, et al. (2021) Risk of transmitting coronavirus disease 2019 during nebulizer treatment: a systematic review. Journal of Aerosol Medicine and Pulmonary Drug Delivery 34(3): 155\u2013170.","journal-title":"Journal of Aerosol Medicine and Pulmonary Drug Delivery"},{"key":"e_1_3_6_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-020-0869-5"},{"key":"e_1_3_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2020.109819"},{"key":"e_1_3_6_12_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.abi5273"},{"key":"e_1_3_6_13_1","unstructured":"Katz SL Greer MK Sahni AS (2021) Aerosol generation risk of chest physiotherapy and airway clearance techniques in patients with COVID-19. 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