Nebulization Optimization for Management of Obstructive Airway Disorders: An Expert Review (NOVA-ER)

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Background: Nebulization therapy is an essential inhalation technique for managing obstructive airway diseases such as asthma, bronchiectasis, and chronic obstructive pulmonary disease (COPD). In Indian clinical settings, factors such as diverse patient populations, varying disease severity, and healthcare accessibility influence treatment decisions. While clinicians rely on the only available nebulization guideline, its vastness and complexity pose challenges in practical application. Navigating these guidelines and translating recommendations into routine practice remains difficult. Objective: The NOVA-ER manuscript aims to develop a structured, evidence-based, and expert-driven reference document to streamline nebulization practices in clinical settings and provide guidance for home nebulization. Methods: A comprehensive review of peer-reviewed literature, clinical guidelines, and systematic reviews was conducted using databases such as PubMed, MEDLINE, and the Cochrane Library, with a focus on studies published in the last ten years to ensure relevance. Additionally, expert opinions were gathered through a structured panel discussion involving specialists in respiratory medicine. A predefined set of questions guided these discussions, and clinical feedback was incorporated to refine recommendations. Key Takeaways: This manuscript presents stepwise algorithms tailored to individual obstructive airway diseases, facilitating decision-making for both rescue and maintenance therapy. It also helps identify suitable candidates and agents for home nebulization while providing disease-specific guidance for effective nebulization treatment. Furthermore, it integrates expert perspectives with current clinical evidence to optimize nebulization practices. Conclusion: NOVA-ER serves as a practical tool for clinicians, researchers, and policymakers, offering structured guidance to enhance nebulization practices, support home nebulization, and bridge the gap between evidence-based guidelines and its practical applicability in clinical care which may help improving patient outcomes.

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