Crisis management for asthma and COPD during the UK Covid-19 epidemic

As Covid-19 cases begin to rise exponentially in the UK, a skilled and thoughtful approach is needed for the management of patients with COPD and asthma presenting in crisis in primary care. Respiratory crisis in these patients may be a result of viral pneumonia, airways disease worsening due to the viral trigger effect or other known triggers for airways disease worsening without Covid-19 infection. Fear and anxiety may also be an underlying factor regardless of the pathological cause.

Patients presenting with an asthma attack or COPD exacerbation should be managed according to current national guidance on the use of inhaled and oral corticosteroids. The shortest duration of increased ICS or oral corticosteroids to gain control of the asthma attack or COPD exacerbation should be used. 

Asthma

There is currently no evidence that ICS increase the risks associated with Covid-19 infection at the present time. Consequently, there is no change to the current recommendations for the use of ICS preventer medication for patients with stable asthma. Patients with stable asthma should be strongly encouraged to continue taking their preventer medication as prescribed. “I have never known so many asthmatic patients want the ICS that they stopped taking a few weeks ago. This is a great opportunity to hammer home the message about the importance of ICS as preventer medication” said Katherine Hickman, GP. See guidance from Asthma UK on managing asthma during the Covid-19 epidemic here. 

COPD exacerbation

For patients with COPD exacerbation, consider carefully whether the benefits of oral steroids will outweigh the risks of worsening any viral illness. Before prescribing steroids, ensure you are advising that the control of symptoms with increased bronchodilation, breathing exercises and pacing, for example and where appropriate, can be highly effective. The absence of high blood eosinophil counts in past FBCs suggests a COPD phenotype with less steroid responsiveness and here, avoidance of steroids is justifiable.

PCRS guidance

PCRS will shortly be issuing more detailed pragmatic guidance on this topic which will be continuously reviewed and updated as the situation in the UK evolves and our knowledge and understanding of this global pandemic increases.
You can now access our dedicated Covid-19 webpage for the latest information advice and helpful links.

Date of preparation: 19 March 2020