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
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

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.

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).