NICE has developed guidelines is to maximise the safety of patients with chronic obstructive pulmonary disease (COPD: FEV1
- Communicate with patients, families and carers about the increased risk of severe COVID-19 with COPD.
- Support their mental health needs, alleviating anxiety and fear.
- Factors associated with a worse prognosis in patients with COPD include:
- past history of hospital admission
- need for long-term oxygen therapy or non-invasive ventilation
- limiting breathlessness
- the presence of frailty and multimorbidity
- Minimise face-to-face contact whenever possible.
- For face-to-face appointments, first screen them for COVID-19 symptoms by phone. Advise that they should contact NHS 111 if they think they have COVID‑19.
- Ask patients to come alone if possible but to avoid public transport.
- Minimise time in the waiting area by:
- careful scheduling
- separate entrance and exit routes
- encouraging patients not to arrive early
- texting/calling patients when you are ready to see them, so that they can wait in their car, for example.
Managing patients with suspected or confirmed COVID-19
- In patients with known or suspected COVID‑19, follow appropriate UK guidance on infection prevention and control.
- In patients with COVID‑19 symptoms, follow UK guidance on investigation and management of possible cases.
- If COVID‑19 is diagnosed after admission or presentation in a patient not isolated, follow government guidance for health professionals.
- All patient should continue taking their regular inhaled and oral medicines.
- Encourage patients with more severe COPD to develop advance care plans.
- Strongly encourage patients who are still smoking to stop.
- Prescribe enough COPD medicines for ≤30 days.
- Explain to patients there is no evidence that inhaled corticosteroids (ICS) increase the risk of COVID‑19.
- While ICS may increase the overall risk of pneumonia, this risk alone does not require a change to treatment.
- Advise patients to carry a Steroid Treatment Card.
- In patients having an exacerbation, start oral corticosteroids and/or antibiotics if clinically indicated.
- Do not offer patients a short course of oral corticosteroids and/or antibiotics to keep at home unless clinically indicated.
- Use online pulmonary rehabilitation resources.
- Patients receiving long-term oxygen therapy should not adjust their oxygen flow rate unless advised to by their healthcare professional.
- Patients receiving ambulatory oxygen should not start using it at rest or at home.
- Do not routinely start prophylactic antibiotics to reduce risk from COVID‑19.
- Patients already being treated with prophylactic antibiotics should continue.
- Patients using airway clearance techniques should continue.
- Inducing sputum is a potentially infectious aerosol-generating procedure, patients should take appropriate precautions such as performing the techniques in a well-ventilated room, away from other family members if possible.
- The aerosol comes from the fluid in the chamber and will not transmit virus from the patient.
- Do not offer nebulisers unless clinically indicated.
- Advise patients currently receiving non-invasive ventilation at home that these are potentially infectious aerosol generating procedures, and should be carried out in a well-ventilated room, away from other family members if possible.
- Follow government guidance on infection prevention and control and using personal protective equipment (PPE).