NICE have released a set of rapid guidelines to help healthcare professionals (HCPs) navigate their way through the COVID-19 pandemic in terms of maximising patient safety and how to make the best use of NHS resources, whilst protecting staff from infection. The guidance covers service delivery during the pandemic, management of symptoms and complications as well as conditions that increase risk such as chronic obstructive pulmonary disease (COPD).
The new guidance on community-based care of patients with COPD [NG168] advises that all patients, including those with suspected or confirmed COVID-19, should continue taking their regular inhaled and oral medicines in line with their individualised self-management plan. Oxygen follow-up assessments can be postponed in patients with COPD to reduce the risk of COVID-19 infection, NICE says.
HCPs should prescribe enough COPD medicines to meet the patient’s clinical needs for no more than 30 days, NICE emphasises, as prescribing larger quantities of medicines ‘puts the supply chain at risk’.
Patients already taking inhaled corticosteroids should carry on taking them and delay any planned trials of withdrawal as there is no evidence that treatment with inhaled corticosteroids for COPD increases the risk associated with COVID-19. Those on long-term oral corticosteroids should also be advised to continue taking them at the prescribed dose, as stopping treatment can be harmful.
If patients think they are having an exacerbation, they should be advised to follow their self-management plan and start a course of oral corticosteroids and/or antibiotics if clinically indicated. They should not start a short course of oral corticosteroids and/or antibiotics for symptoms of COVID-19, for example fever, dry cough or myalgia. Prescribers should not offer patients with COPD a short course of oral corticosteroids and/or antibiotics to keep at home ‘unless clinically indicated’.
Patients receiving long-term oxygen therapy should not adjust their oxygen flow rate unless advised to by a healthcare professional. Patients receiving ambulatory oxygen should be advised not to start using it at rest or in their home.
The guidance says HCPs should find out if patients have advance care plans and encourage those with severe COPD to develop one if not. These discussions may need to take place remotely, NICE adds.
Patients with COPD who are still smoking should be strongly encouraged to stop and provided with support and evidence-based interventions as needed.
NICE also advises prescribers to be alert at every interaction with patients for new or worsening issues with mental health and wellbeing.
Patients with COPD who think they have COVID-19 should be advised to contact NHS 111 online coronavirus service or call NHS 111.