Diagnostic work up of the patient presenting with respiratory symptoms in the era of Covid-19

Concerned about diagnosing patients presenting with respiratory symptoms? Help is at hand. PCRS have now issued a position statement and recommendations for clinicians on the diagnostic work up of patients presenting with respiratory symptoms while Covid-19 remains in active circulation. The recommendations bring together the cross-functional experience of PCRS members on the safest and most appropriate approach when evaluating patients presenting with respiratory symptoms.

The challenge facing clinicians is to ensure a comprehensive evaluation that allows an accurate diagnosis to be reached while minimising the risk for cross-infection. The recommendations from PCRS recognise that certain procedures with the potential to for droplet or aerosol formation such as spirometry may not be possible or appropriate under the current situation and offer pragmatic advice on diagnosis based on history, physical examination and presenting symptoms. For patients for whom asthma is suspected, a monitored trial of treatment is appropriate, for those with suspected COPD, peak expiratory flow rate (PEFR) can be informative although it is necessary to ensure the patient is well trained to undertake PEFR independently. Confirmatory spirometry can be deferred for when it is considered safe and is readily available. Spirometry should be reserved for those in whom the diagnosis is equivocal and is necessary to determine the appropriate treatment course.

While Covid-19 continues to actively circulate in the community, it is essential that patients presenting with respiratory symptoms are assessed by a healthcare profession with suitable training and experience. When testing procedures with the potential for cross-infection are considered necessary, the patient should ideally be referred to a networked respiratory diagnostic service.

You can read the full recommendations through the PCRS Opinion page Diagnostic work up of the patient presenting with respiratory symptoms during the Covid-19 pandemic. You can also learn more about the PCRS view of networked respiratory diagnostic services through the PCRS Diagnostic Service Specification. Finally, you can access the PCRS dedicated Covid-19 webpage for the latest information advice and helpful links.