NICE issue rapid guidelines on the community management of patients with COPD

NICE issue rapid guidelines on the community management of patients with COPD

NICE has issued new rapid guidance on keeping safe those patients in the community with COPD. All people with COPD are at increased risk from COVID-19 infection and need to receive this message but there are special instructions for those considered at greatest risk.

NICE highlights those features suggestive of severe disease that are associated with worse outcomes from COVID-19. This includes those with a past history of hospital admission, who need long-term oxygen therapy or non-invasive ventilation, whose breathlessness limits their activities and those who are frail or have multiple comorbid conditions. NICE also re-states that an FEV₁ of less than 50% predicted is classified as severe airways obstruction.

Understanding who these patients are is critical to ensuring they and their families and carers are aware of how best to shield themselves. Some will have already received a letter informing them of their status but there will be those who haven’t who you may consider as their health professional as also being in this group.

For all people with COPD, face-to-face contact should be minimised to reduce the risk of infection by:

1. Using telephone, video or email consultations whenever possible
2. Cutting non-essential face-to-face appointments
3. Contacting patients via text message, telephone or email
4. Using electronic prescriptions rather than paper
5. Using different methods to deliver proscriptions and medicines to patients such as pharmacy deliveries, postal services, NHS volunteers

The guidance also stipulates that all patients with COPD, including those with or suspected of having COVID-19, should be advised to continue taking their prescribed medications in line with their individualised COPD self-management plan if they have one. There is no evidence that ICS increase the risk of getting COVID-19 and stopping ICS or maintenance oral corticosteroids can be harmful. Patients who develop symptoms of a COPD exacerbation should follow their individualised COPD self-management plan and start a course of oral corticosteroids and/or antibiotics if clinically indicated, unless  their symptoms are suggestive of COVID-19 infection including fever, dry cough or myalgia. For those receiving long-term oxygen, they should not adjust their oxygen flow rate unless advised to do so by a healthcare professional. Patients should be encouraged to use online pulmonary rehabilitation services such as those provided by the British Thoracic Society. Patients with most severe disease who do not have an individualised advance care plan should be encouraged to develop one.

PCRS have published pragmatic guidance on managing patients presenting with respiratory symptoms in the community which you can access here. Patients with COPD who are still smoking should be strongly encouraged to stop to reduce the risk of poor outcomes from COVID-19 and their risk of acute COPD exacerbations. You can access the PCRS pragmatic guide to smoking cessation here.

You can access the PCRS dedicated COVID-19 webpage for the latest information advice and helpful links.