Recomendaciones para calefacción, ventilación y aire acondicionado en establecimientos de salud, octubre del 2020 / Recommendations for Heating, Ventilation, and Air Conditioning in Healthcare Facilities, October 2020

Proporcionar condiciones térmicas y sistemas de ventilación adecuados que eviten la dispersión de patógenos es fundamental para proteger la salud de los pacientes, de los profesionales médicos y de enfermería, y del resto del personal, así como para el funcionamiento general de los equipos sensibles. Esta segunda versión presenta recomendaciones generales para evitar la transmisión del SARS-CoV-2 a través de sistemas de calefacción, ventilación y aire acondicionado en establecimientos de salud.

Providing adequate thermal conditions and ventilation systems that prevent the dispersion of pathogens, is fundamental to protect the health of patients, caregivers and staff, and to the overall operation of sensitive equipment. This technical note presents general recommendations to prevent the transmission of SARS-CoV-2 through heating, ventilation, and air conditioning systems in ​health care facilities.

Low Cost Equipment with Compressor System and Balanced Pressure to Protect the Professional Dentist Against Contaminated Aerosol During COVID-19 Pandemic / Equipo de Bajo Costo con Sistema de Compresor y Presión Equilibrada para Proteger al Dentista Profesional Contra el Aerosol Contaminado Durante la Pandemia COVID-19

ABSTRACT: During the current coronavirus epidemic, personal protective equipment has become a vital issue. Depending on the procedure, the generation of aerosols increases the risk of infection for healthcare professionals. However, in dentistry, there is a high risk of contamination from blood or tissue fluids, generated in surgical procedures with ultrason ic and high-speed cutting devices. Thus, the creation of a prototype with a functional respiratory protection system offers filtered air at the entrance and exit of the circuit, also benefiting the patient. This experimental and unprecedented air purification system has 99.9 % high efficiency filters, positive and negative pressure control and also generates an internal balance of air flow; its purpose is to maintain the facial seal of the snorkel mask. The results showed that this air purificat ion system could be an option in environments contaminated by aerosol caused by rotary intruments in dentistry.

RESUMEN: Durante la actual epidemia de coronavirus, el equipo de protección personal se ha convertido en un problema vital. Dependiendo del procedimiento, la generación de aerosoles aumenta el riesgo de infección para los profesionales de la salud. Sin embargo, en odontología, existe un alto riesgo de contaminación por sangre o fluidos tisulares, generados en procedimientos quirúrgicos con dispositivos de corte ultrasónicos y de alta velocidad. Por lo tanto, la creación de un prototipo con un sistema funcional de protección respiratoria ofrece aire filtrado a la entrada y salida del circuito, lo que también beneficia al paciente. Este sistema de purificación de aire experimental y sin precedentes tiene 99.9 % de filtros de alta eficiencia, control de presión positiva y negativa y también genera un equilibrio interno del flujo de aire; Su propósito es mantener el sello facial de la máscara de snorkel. Los resultados mostraron que este sistema de purificación de aire podría ser una opción en ambientes contaminados por aerosoles causados por instrumentos rotativos en odontología.

Recomendaciones para calefacción, ventilación y aire acondicionado en establecimientos de salud, 21 de mayo del 2020 / Recommendations for Heating, Ventilation, and Air Conditioning in Health Care Facilities, 21 May 2020

Esta ficha técnica presenta recomendaciones generales para evitar la transmisión del SARS-CoV-2 por medio de sistemas de calefacción, ventilación y aire acondicionado en establecimientos de salud.

This technical note presents general recommendations to prevent the transmission of SARS-CoV-2 through heating, ventilation, and air conditioning systems in ​health care facilities.

Associated Factors for Asthma Severity in Korean Children: A Korean Childhood Asthma Study

PURPOSE: Childhood asthma has a considerable social impact and economic burden, especially in severe asthma. This study aimed to identify the proportion of childhood asthma severity and to evaluate associated factors for greater asthma severity. METHODS: This study was performed on 667 children aged 5–15 years with asthma from the nationwide 19 hospitals in the Korean childhood Asthma Study (KAS). Asthma was classified as mild intermittent, mild persistent, and moderate/severe persistent groups according to the National Asthma Education and Prevention Program recommendations. Multinomial logistic regression models were used to identify the associated factors for greater asthma severity. RESULTS: Mild persistent asthma was most prevalent (39.0%), followed by mild intermittent (37.6%), moderate persistent (22.8%), and severe persistent asthma (0.6%). Onset later than 6 years of age (adjusted odds ratio [aOR], 1.69 for mild persistent asthma; aOR, 1.92 for moderate/severe persistent asthma) tended to increase asthma severity. Exposure to environmental tobacco smoke (aOR, 1.53 for mild persistent asthma; aOR, 1.85 for moderate/severe persistent asthma), and current dog ownership with sensitization to dog dander (aOR, 5.86 for mild persistent asthma; aOR, 6.90 for moderate/severe persistent asthma) showed increasing trends with greater asthma severity. Lower maternal education levels (aOR, 2.32) and no usage of an air purifier in exposure to high levels of outdoor air pollution (aOR, 1.76) were associated with moderate/severe persistent asthma. CONCLUSIONS: Modification of identified environmental factors associated with greater asthma severity might help better control childhood asthma, thereby reducing the disease burden due to childhood asthma.

Reuse process of positive pressure powered air-filter protective hoods / 浙江大学学报·医学版

OBJECTIVE@#To establish reuse process of positive pressure powered air-filter protective hoods during coronavirus disease 2019 (COVID-19) epidemic.@*METHODS@#The procedure of pretreatment, storage, recovery, cleaning, disinfection and sterilization process of positive pressure powered air-filter protective hoods, which were used in the treatment of COVID-19 infection patients was established in Central Sterile Supply Department of the hospital. The cleaning and disinfection effects of the protective hoods after treatment were examined by magnifying glass method, residual protein detection method, real-time PCR, and agar pour plate method.@*RESULTS@#Twenty five used protective hoods underwent totally 135 times of washing, disinfecting and sterilizing procedures. After washing, all the protein residue tests and COVID-19 nucleic acid tests showed negative results. After sterilizing, all the protective hoods met sterility requirement. All the tested protective hoods were undamaged after reprocessing.@*CONCLUSIONS@#The established reuse procedures for used positive pressure powered air-filter protective hoods are safe.

Eletrocauterização de verrugas venéreas: presença de bioaerossóis na fumaça cirúrgica / Eletrocauterization of venerealwarts: presence of bioaerosols in surgical smoke

Objective:to analyze the capacity of the bioaerosol retention filters with the use of a surgical smoke aspirator in procedures of cauterization of venereal warts. Method:field, descriptive, cross-sectional and quantitative research. The study was developedat a referral center for sexually transmitted infections in the northern state of Paraná, in the urology outpatient clinic. Data collection was collected from April to July 2016, with a sample obtained from 72 cauterization procedures. A descriptive statistical analysis was performed. Results:24 filters attached in two equipment, used to vacuum the smoke were analyzed. The conventional Polymerase Chain Reaction method was used to read the filters, using specific primers to search for Simple Herpes, HerpesZoster, Hepatitis C, Human Immunodeficiency Virus, Hepatitis B and Human Virus Papilloma. From the analyzed samples were found Viral Deoxyribonucleic Acid from Herpes Simplex, Hepatitis B and Human Virus Papilloma in the analyzed filters. Conclusion:the use of surgical vacuum aspiration equipment with Ultra-low Particulate Air filters during the cauterization of venereal warts was able to retain bioaerosols when the filter replacement time was respected.

Objetivo:analisar a capacidade dos filtros de retenção de bioaerossóis com o uso de aspirador de fumaça cirúrgica em procedimentos de cauterização de verrugas venéreas. Método: pesquisa de campo, descritiva, transversal e quantitativa. O estudo foi desenvolvido em um centro de referência para infecções sexualmente transmissíveis no Norte do estado do Paraná, no ambulatório de urologia. A coleta de dados foi realizada no período de abril a julho de 2016, com uma amostra obtida a partir de 72 procedimentosde cauterização. Realizou-se análise estatística descritiva. Resultados:foram analisados 24 filtros acoplados em dois equipamentos, utilizados para aspiração da fumaça. O método da Reação em Cadeia da Polimerase convencional foi utilizado para a leitura dos filtros, sendo utilizados primersespecíficos para a pesquisa de Herpes Simples, Herpes Zoster, Hepatite C, Vírus da Imunodeficiência Humana, Hepatite B e Papiloma Vírus Humano. A partir das amostras analisadas foram encontrados Ácido Desoxirribonucleico viral do Herpes Simples, Hepatite B e Papiloma Vírus Humano nos filtros analisados. Conclusão: O uso de um equipamento de aspiração de fumaça cirúrgica, com filtros Ultra-low Particulate Air, durante as cauterizações de verrugas venéreas mostrou-se capaz de reter bioaerossóis quando respeitado o tempo de troca dos filtros.

Effect of the air filtration system replacement on embryo quality in the assisted reproduction laboratory / Efeito da troca do sistema de filtragem do ar na qualidade embrionária no laboratório de reprodução assistida

Abstract Improving infrastructural conditions of the in vitro fertilization laboratory, such as the air quality, has profound positive effects on embryo culture. Poor environmental conditions reduce the rate of embryo formation and, therefore, of pregnancy. This review article presents important publications regarding the impact of air quality in human reproduction laboratories on embryo quality, pregnancy success, and live births. The studies demonstrate that the replacing the air filtration system improves significantly the environmental air quality, and, consequently, improves laboratory parameters, such as the fertilization rate, the number of blastocysts, the embryo implantation rate, and the number of live births. On the other hand, improving air quality decreases the number of abortions. Therefore, environmental parameters that improve embryo quality and increase healthy child birth ratesmust be themain targets for the assisted reproduction laboratory quality control.

Resumo Melhorar as condições de infraestrutura do laboratório de fertilização in vitro, com influência na qualidade do ar, tem efeitos positivos profundos na qualidade do embrião. As más condições ambientais do ar reduzem a taxa de sucesso na formação de embriões e a taxa de gravidez. Este artigo de revisão apresenta importantes publicações sobre o impacto da qualidade do ar dentro do laboratório de reprodução humana na qualidade do embrião, no sucesso de gravidez e no número de nascidos vivos. Os estudos demonstram que a troca do sistema de filtração de ar melhora significativamente a qualidade do ar ambiente, e consequentemente, melhora os parâmetros laboratoriais, tais como a taxa de fertilização, o número de blastocistos, a taxa de implantação e o número de nascidos vivos. Por outro lado,amelhora da qualidade do ar diminui o número de abortos. Portanto, os parâmetros ambientais que melhoram a qualidade do embrião e aumentam as taxas de nascimentos de crianças saudáveis devem ser os principais alvos para o controle de qualidade do laboratório de reprodução assistida.

Health effects of particulate matter

Particulate matter is an air pollutant emitted from both natural and anthropogenic sources, and its adverse health effects have been well documented in time-series analyses and cohort studies. The effect size of particulate matter exposure—a roughly 0.5% increase in mortality for each 10 µg/m³ increment of short-term exposure to particulate matter with aerodynamic diameter ≤10 µm and approximately a 10% increase for each 10 µg/m³ increment of long-term exposure to particulate matter with aerodynamic diameter ≤2.5 µm—is small compared to other risk factors, but the exposure is involuntary and affects the entire population, which makes particulate matter pollution an important public health issue. The World Health Organization and Korean government have both established guidelines for particulate matter concentrations, but the Korean guideline is less stringent than that of the World Health Organization. The annual mean concentration of particulate matter in Korea is decreasing, but the trend seems to be slowing. In addition to policy efforts to reduce particulate matter emission, personal approaches such as the use of face masks and air purifiers have been recommended. Personal approaches may not solve the fundamental problem, but can provide temporary mitigation until efforts to reduce emission make progress.

Effects of high-efficiency particulate air purifiers on indoor fine particulate matter and its constituents in a district of Beijing during winter / 北京大学学报(医学版)

OBJECTIVE@#To analyze the effect of domestic high-efficiency particulate air (HEPA) purifiers on the concentrations of indoor fine particulate matter (PM2.5) and its elementary constituents in 20 residences in a district of Beijing during winter.@*METHODS@#From November 2015 to January 2016, 20 residences in a district of Beijing were selected, where indoor and outdoor PM2.5 data were collected simultaneously in three time periods according to the operating of air purifiers (Group 0 h: 24 hours before operating; Group 24 h: 24 hours after operating; Group 48 h: 24 to 48 hours after operating). The content of 21 elements in PM2.5 samples were determined by inductively coupled plasma mass spectrometry (ICP-MS) and inductively coupled plasma optical emission spectrometry (ICP-OES). Indoor/outdoor particle concentration ratio (I/O ratios) and ΔI/O ratios were used to describe the pollution levels and the variation range of PM2.5 and its 21 elementary constituents. One-way analysis of variance (ANOVA) for repeated measurement data was applied to compare the I/O ratios of PM2.5 and its elementary constituents among the different groups, and Bonferroni method was used for comparison in pairs. Wilcoxon signed rank test for paired-samples was used to compare ΔI/O ratios of 21 elementary constituents with that of PM2.5.@*RESULTS@#The median I/O ratios of PM2.5 in the three groups were 1.27 (P25-P75: 0.50-2.68), 0.45 (P25-P75: 0.27-1.03) and 0.36 (P25-P75: 0.28-2.48), respectively. Compared with Group 0 h, the I/O ratios of PM2.5 in Group 24 h (P=0.042) and Group 48 h (P=0.006) decreased significantly. However, there was no significant difference between Group 24 h and Group 48 h. Significant differences were found comparing ΔI/O ratios of aluminium, ferrum and titanium to that of PM2.5, in both Group 24 h and Group 48 h (P<0.05). No significant change was found in the I/O ratios of these three elements among the three groups before and after air purifier operating (P>0.05). Distances from residences to traffic arteries could affect I/O ratios of some elements from traffic-related source (P<0.05).@*CONCLUSION@#Domestic HEPA air purifiers could effectively reduce indoor PM2.5 concentration, and the pollution level of PM2.5 tend to be stable after the purifier operating for a time. The purifiers had different effects on different elements, among which most showed statistical significances.

Adsorption of desflurane by the silica gel filters in breathing circuits: an in vitro study / 대한마취과학회지

BACKGROUND: During general anesthesia, a heated breathing circuit (HBC) is used to replace the heat and moisture exchange function of the upper airway. One HBC uses an air dryer filter that employs silica gel (SG) as a desiccant. SG is capable of adsorbing many organic compounds. Therefore, we undertook an in vitro study of the adsorption of desflurane by SG filters. METHODS: An HBC was connected to an anesthesia machine, and a test lung was connected to the circuit. The test lung was mechanically ventilated with 2 or 4 L/min of fresh gas flow, with and without the air dryer filter. Desflurane was administered at a 6 vol% on the vaporizer dial setting. The experiment was repeated 15 times in each group. The end-tidal concentrations were measured during the experiments. The air dryer filter weights were measured before and after the experiments, and the times required to achieve the specific end-tidal desflurane concentrations were determined. RESULTS: Significant differences in the end-tidal concentrations of desflurane were observed between the control and filter groups (P < 0.001). The filter weights increased significantly after the experiments (P < 0.001). The times required to achieve the same end-tidal desflurane concentrations were different with the application of the air dryer filter (P < 0.001). CONCLUSIONS: The adsorption of desflurane with the use of an air dryer filter was verified in this in vitro study. Careful attention is needed when using air dryer gel filters during general anesthesia.

Mold Occurring on the Air Cleaner High-Efficiency Particulate Air Filters Used in the Houses of Child Patients with Atopic Dermatitis

Fungi are the known sources of irritation associated with atopic diseases (e.g., asthma, allergic rhinoconjunctivitis, and atopic eczema). To quantitatively estimate their presence in the indoor environment of atopic dermatitis-inflicted child patient's houses (ADCPHs), the high-efficiency particulate air (HEPA) filters installed inside the air cleaners of three different ADCPHs were investigated for the presence of mold. The air cleaner HEPA filters obtained from the three different ADCPHs were coded as HEPA-A, -B, and -C, respectively, and tested for the presence of mold. The colony forming units (CFUs) corresponding to the HEPA-A, -B, and -C filters were estimated to be 6.51 x 10(2) +/- 1.50 x 10(2) CFU/cm2, 8.72 x 10(2) +/- 1.69 x 10(2) CFU/cm2, and 9.71 x 10(2) +/- 1.35 x 10(2) CFU/cm2, respectively. Aspergillus, Penicillium, Alternaria, Cladosporium, Trichoderma, and other fungal groups were detected in the 2,494 isolates. The distribution of these fungal groups differed among the three filters. Cladosporium was the major fungal group in filters HEPA-A and -C, whereas Penicillium was the major fungal group in the filter HEPA-B. Nine fungal species, including some of the known allergenic species, were identified in these isolates. Cladosporium cladosporioides was the most common mold among all the three filters. This is the first report on the presence of fungi in the air cleaner HEPA filters from ADCPHs in Korea.

Efficacy of the Precise Climate Controller on the reduction of indoor microorganisms

BACKGROUND: Nowadays, there are many methods to reduce microorganisms in the air, such as dehumidifier, air purifier or humidity and temperature controller. The Precise Climate Controller is an instrument for controlling humidity and temperature, a concept that is demonstrated. OBJECTIVE: To determine the efficacy of this device, in order to reduce the quantity of the fungi and bacteria in the closed system.

Assessment of microbiological air quality in hemato-oncology units and its relationship with the occurrence of invasive fungal infections: an integrative review

Worldwide aging of the human population has promoted an increase in the incidence of neoplasia, including hematological cancers, which render patients particularly vulnerable to invasive fungal infections. For this reason, air filtration in hemato-oncology units has been recommended. However, scarce literature has assessed the impact of microbiological air quality on the occurrence of fungal infections in this population. We performed an integrative review of studies in the MEDLINE database that were published between January 1980 and October 2012, using the following combinations of keywords: air × quality × HEPA, air × quality × hematology, and airborne fungal infections. The search yielded only 13 articles, suggesting that high-efficiency filtering of the ambient air in hemato-oncology units can prevent the incidence of invasive fungal infections. However, no randomized clinical trial was found to confirm this suggestion. Currently, there is no consensus about the maximum allowable count of fungi in the air, which complicates filtration monitoring, including filter maintenance and replacement, and needs to be addressed in future studies.

Evaluation of vaporized hydrogen peroxide fumigation as a method for the bio-decontamination of the high efficiency particulate air filter unit / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To evaluate the performance of vaporized hydrogen peroxide (VHP) for the bio-decontamination of the high efficiency particulate air (HEPA) filter unit.</p><p><b>METHODS</b>Self-made or commercially available bioindicators were placed at designated locations in the HEPA filter unit under VHP fumigation. The spores on coupons were then extracted by 0.5 h submergence in eluent followed by 200- time violent knocks.</p><p><b>RESULTS</b>Due to the presence of HEPA filter in the box, spore recovery from coupons placed at the bottom of the filter downstream was significantly higher than that from coupons placed at the other locations. The gap of decontamination efficiency between the top and the bottom of the filter downstream became narrower with the exposure time extended. The decontamination efficiency of the bottom of the filter downstream only improved gently with the injection rate of H2O2 increased and the decontamination efficiency decreased instead when the injection rate exceeded 2.5 g/min. The commercially available bioindicators were competent to indicate the disinfection efficiency of VHP for the HEPA filter unit.</p><p><b>CONCLUSION</b>This assay developed can detect all 16 β-lactams demanded by the European Union (EU). The whole procedure takes only 45 min and can detect 42 samples and the standards with duplicate analysis.</p>

Multiple chemical sensitivity caused by exposure to ignition coal fumes: a case report

BACKGROUND: Although multiple chemical sensitivity (MCS) is a well-known disorder caused by environmental exposures, MCS caused by occupational exposure has been reported in Korea. Therefore, we report a MCS case caused by environmental exposure to ignition coal after a differential diagnosis to exclude other diseases. CASE REPORT: Since 2011, a 55-year-old woman had experienced edema, myalgia, and other symptoms when she smelled ignition coal near her workplace. She had been diagnosed with fibromyalgia syndrome(FMS) and was treated, with no improvement of symptoms. Since then, she showed the same symptoms after exposure to city gas, the smell of burning, and exhaust gas. To avoid triggering substances, she moved to a new house and used an air purifier. She quit her job in November 2012. After visiting our hospital, she underwent a differential diagnosis for FMS, chronic fatigue syndrome, and somatization disorder. She was diagnosed with MCS by the Korean version of the Quick Environment Exposure Sensitivity Inventory (QEESI). She was educated about the disease and to avoid triggering substances. She received ongoing treatment for her symptoms. CONCLUSION: This case showed that symptoms began after smelling ignition coal. After that, her triggers was increased such as the smell of city gas, burning, and exhaust gas. This case is the first reported in Korea of MCS due to environmental exposure after ruling out other diseases.

Effect of air purifier on indoor air quality and atopic dermatitis

PURPOSE: High level of indoor air pollutant may cause aggravation of atopic diseases long with various allergic respiratory diseases especially in people who spend mostly of their lives indoors. The aim of this study was to evaluate the effect of air purifier on the reduction of relevant hazards in indoors and the improvement of atopic dermatitis (AD). METHODS: A total of 24 families, consisted of 18 AD families and 6 normal control families, were enrolled in this study. We examined air quality and AD severity before the installation of air purifiers and after twenty-four weeeks. The assessment of air quality included fine particles (particulate matter, PM2.5 and PM10), gaseous contaminants (CO, CO2, volatile organic compounds [VOCs], formaldehyde, NO2) and density of offloating microorganisms. Severity of AD was assessed by SCORing atopic dermatitis (SCORAD) index and transepidermal water loss (TEWL). RESULTS: At the end of study, particular air pollutants and VOCs of gaseous air pollutants decreased in both groups (P<0.01). In AD group, SCORAD index decreased from 23.45+/-4.34 to 15.42+/-6.53 (-18.5%) and TEWL decreased from 33.78+/-5.16 to 26.89+/-5.66 (-18.7%) (P<0.01 and P<0.01, respectively). However, the value of total immunoglobulin E and eosinophil did not show significant changes in both groups compared with baseline. CONCLUSION: These results suggested that air purifier may improve severity of AD by reducing air pollutants like fine particles and VOCs. Our preliminary study could provide a basis for using air purifier to prevent aggravation of AD.

Removal of triethylamine vapor from waste gases by biotrickling filter

Sampling of triethylamine in the cold-box unit in an auto-manufacturing company in Iran has indicated the average concentration of 430 mg/m[3] in the emission duct. In this study a biotrickling filter was used for treatment of triethylamine in air stream. Triethylamine removal efficiency [K/L] pattern was evaluated by changing volumetric loading [L], superficial gas velocity [U[o]], empty bed gas retention time [EBRT] and recirculation liquid flow rate [V[L]], while operating at constant temperature of 25 +/- 1 Degree C. For finding the effect of EBRT on the triethylamine removal efficiency, tests were performed at EBRT of 156 s, 52s and 31s and a constant liquid recirculation velocity of 3.466 m[3]/m[2]/h. Results showded that for a test period of 65 days, triethylamine removal efficiencies of more than 98% were obtained for EBRT of 156s and loading rates of less than 48 g/m[3]/h. With an EBRT of 52s removal efficiencies of > 90% were obtained for loadings of < 57 g/m[3]/h and maximum removal capacity was 53.4 g/m[3]/h at volumetric loading of 64 g/m[3]/h. Also with an EBRT of 31 s the maximum removal capacity was 53.6 g/m[3]/h at volumetric loading of 68 g/m[3]/h. Thus in the range of implemented EBRTs the proper absorption of triethylamine from gas to liquid phase took place and the elimination efficiency was shown to be dependent on microorganisms activity rate. The effect of liquid flow rate on the triethylamine removal efficiency was investigated by changing VL in the range of 3.46 to 10.40 m[3]/m[2]/h at EBRT=31 s and influent triethylamine concentration of 600 mg/m[3]. Results showed that the triethylamine removal efficiency was nearly independent of the liquid recirculation rate

The Study of Home Nebulizer Use in Asthmatic Children / 소아알레르기및호흡기학회지

PURPOSE: Inhalational therapy is now one of the major method in managing asthma. Nebulizer is widely used at home nowadays, but there has been no survey on the usage of home nebulizer in Korea yet. This study was performed using questionnaires to evaluate that how the asthmatic patients use the personal nebulizer properly as an treatment tool for asthma. METHODS: Forty-six asthmatic children living in Chunlabukdo area in Korea who use the personoa nebulizer at home from October 1999 to March 2000 were enrolled. Personal history, purpose of personal nebulizer, understanding of the instruction to use were analyzed using questionnaires. RESULTS: 1) The sex ratio was not statistically significant (M : F ratio was 1.3 : 1) and the mean age was 3.7 years. 2) Thirty-seven cases (80.4%) purchased nebulizer by doctor's recommendation. 6 cases (13.1%) by personal need without doctor's recommendation and 3 cases (6.5%) by acquaintances' recommendation. 47.8% of patients purchased through small-scale suppliers. 32.6% purchased through hospital, and 19.6% through large nebulizer manufacturers. 3) Sixty-three percents of patients had an explanations about the basic instructions to use the nebulizer. Explanations on maintenance were given only in 19.6% of total and was mostly given through large nebulizer manufacturers. 4) Proper washing with sterilization took place in 54.3%, replacement of kits and air filters were done in only 15.2% of the total, but nobody was recommended annual check up. 5) There was no difference in the techniques of using nebulizers by the parents' level of knowledge about asthma. CONCLUSION: Many problems on the usage of personal home nebulizer in asthmatic children were revealed by this study. Education of patients on how to use and manage nebulizers is necessary when prescribe or sell the nebulizers.