NICE guidelines on COPD and COVID-19: a summary of key recommendations

  • National Institute for Health and Care Excellence

  • curated by Dawn O'Shea
  • Clinical Guidance Summaries
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NICE has developed guidelines is to maximise the safety of patients with chronic obstructive pulmonary disease (COPD: FEV1

General recommendations

  • 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:
  1. past history of hospital admission
  2. need for long-term oxygen therapy or non-invasive ventilation
  3. limiting breathlessness
  4. the presence of frailty and multimorbidity

Face-to-face contact

  • 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:
  1. careful scheduling
  2. separate entrance and exit routes
  3. encouraging patients not to arrive early
  4. 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.

Airway clearance

  • 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.

Non-invasive ventilation

  • 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.

Healthcare providers

  • Follow government guidance on infection prevention and control and using personal protective equipment (PPE).