NICE has published guidelines on managing patients with cystic fibrosis (CF) during the COVID-19 pandemic. Here, Univadis provides a summary of the key recommendations:
- Communicate with patients, their families and carers about their increased risk of severe COVID-19.
- Be aware that some patients, families or carers may need specialist psychological or social work support in the context of COVID‑19.
- Sputum generation is a potentially infectious aerosol-generating procedure for COVID‑19. Patients with symptoms of COVID‑19 should carry out airway clearance in a well-ventilated room, separate from other household members if possible.
- Tell patients, families and carers to follow UK government guidance on shielding and protecting people defined on medical grounds as extremely vulnerable.
- Explain to patients, families and carers that when a nebuliser is used to administer an antibiotic, the aerosol comes from the fluid in the nebuliser chamber and will not carry virus particles from the patient. Use appropriate hand hygiene when helping patients with their nebuliser mask to prevent spread from a contaminated droplet that could be formed if the aerosol coalesces with a contaminated mucous membrane.
- Patients, families and carers should practice good hand hygiene and should regularly use washing-up liquid or following the manufacturer's cleaning instructions to clean equipment.
- Be aware that symptoms of COVID‑19 and pulmonary disease exacerbations may be difficult to differentiate at the initial presentation.
- Minimise face-to-face contact whenever possible.
- For patients who need face-to-face appointments, ensure existing arrangements to prevent cross-infection include COVID‑19.
- Ask patients to attend face-to-face appointments alone or with no more than one other person, and advice not to use public transport.
- Report known or suspected cases of COVID‑19 to the UK cystic fibrosis registry reporting hotline on the same day by emailing [email protected] to request a call back.
Changes to usual care
- Day-case facilities may be necessary for procedures such as administering first doses of intravenous antibiotics for courses to be delivered at home and flushing totally implantable intravenous devices.
- Flushing frequency may be reduced from usual practice. Consider home visits.
- Only carry out lung function tests in the hospital if the results will have a direct impact on patient care. Use home spirometry if possible.
- Defer the transition of young people to adult services until the pressures associated with the COVID‑19 pandemic have passed.
Treatment and care planning
- All usual self-care should continue including, for example:
(i) airway clearance techniques
(ii) prophylactic medication, including oral and inhaled antibiotics, and mucoactive agents
(iii) cystic fibrosis transmembrane conductance regulator (CFTR) therapies
(iv) diet, vitamins and pancreatic enzyme replacement therapy
(v) home exercise.
- Prescribe usual quantities of medicines to meet clinical needs. Prescribing larger quantities of medicines puts the supply chain at risk.
- Patients with CF can still access CF transmembrane conductance regulator (CFTR) therapies under NHS England policy statement.
- Select patients for transplant on a case-by-case basis. Refer only in exceptional circumstances.
- Patients should follow previous advice on what to do if they have an exacerbation.
- If a patient has symptoms of COVID‑19 on presentation or admission, follow UK government guidance on investigation and initial clinical management of possible cases.
- Monitor patients with CF closely, as they may be at greater risk of rapid deterioration if they contract COVID‑19.