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

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.

Corticosteroids

• 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.

Rehabilitation

• Use online pulmonary rehabilitation resources.

Oxygen

• 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.

Antibiotics

• 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.

Nebulisers

• 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).