COPD Foundation Nebulizer Consortium Releases Guidance on Mitigating Infection Risk During Nebulization

April 15, 2024

Document Focuses on Health Care Settings and Home Environments

MIAMI (April 15, 2024) – A guidance statement from the COPD Foundation Nebulizer Consortium (CNC) on the safe use of nebulized therapies in health care settings and home environments has been published in the March 2024 issue of CHEST, a peer-reviewed medical journal.

Nebulizers are commonly used to deliver inhaled medications to people with respiratory illnesses, including chronic obstructive pulmonary disease (COPD). These devices are especially important to individuals who may not receive the full benefit of medication delivered by handheld inhalers.

There is currently a lack of evidence on the safe use of nebulizer therapies and the increased risk of transmitting disease, particularly in the current COVID-19 environment. The CNC’s goal is to understand infection risks that may be associated with nebulizer therapy use, so that guidelines are developed to ensure the safety of people receiving nebulizer therapy, as well as those around them.

“In light of the COVID-19 pandemic, it is increasingly important to establish guidelines for the safe use of nebulizer therapies, which are vital to people with COPD and other respiratory illnesses,” said Isaac N. Biney, MD, pulmonologist at the University of Tennessee Medical Center and the lead author of the guideline. “These recommendations address the safe use of these therapies while helping to minimize the risk of exposure to respiratory pathogens for patients, caregivers, and health care providers.”

Since nebulizer use varies based on setting, the CNC’s guideline is divided into two sets: recommendations for health care settings and recommendations for home environments.

Twelve recommendations were made for health care settings, with the top three being:

  • While administering nebulizer therapy to patients with respiratory infections, health care workers should wear a mask, preferably an N95 respirator.
  • A mouthpiece with an attached filter should be the preferred interface if the patient can use it effectively.
  • Aseptic techniques should be adhered to during the medication loading process.

Six recommendations were made for the home environment, with the top three being:

  • Strictly adhere to the manufacturer’s guidelines for cleaning and disinfecting the device.
  • Adhere to aseptic principles during the medication loading process.
  • Treatments should be administered either in an area where the air is not recirculated into the house or near an open window.

“These guidelines are a starting point for ensuring safe nebulized therapy delivery in situations where it is clinically indicated,” said Dr. Biney. “Future research is needed on the risk of disease transmission based on specific treatment situations and different nebulizer types, as well as to evaluate the effectiveness of risk mitigation strategies.”

The recommendations were developed based on a literature review of 86 relevant articles from global literature and existing guidelines on nebulization, published from 2000 to 2022.

To read the full guidelines, visit CHEST. For more information about the CNC, COPD or the COPD Foundation, visit


About the COPD Foundation
The COPD Foundation is a nonprofit organization whose mission is to help millions of people live longer and healthier lives by advancing research, advocacy, and awareness to stop COPD, bronchiectasis, and NTM lung disease. The Foundation does this through scientific research, education, advocacy, and awareness to prevent disease, slow progression, and find a cure. For more information, visit, or follow us on Twitter and LinkedIn.

About the COPD Foundation Nebulizer Consortium
The CNC, established in 2020, is a multidisciplinary, international collaboration of patient advocates, pulmonology physicians, critical care physicians, respiratory therapists, clinical scientists, and pharmacists representing research centers, medical centers, professional societies, industry and government agencies. The CNC is generously supported by Theravance Biopharma US, Inc., Aerogen Limited, Monaghan Medical and PARI Respiratory, Inc.

Brittany Irish