PCRS issue pragmatic guidance for crisis management of asthma and COPD during the UK Covid-19 epidemic

PCRS has today issued pragmatic guidance for the routine and crisis management of patients with asthma and COPD during the UK Covid-19 epidemic. The guide has been written to response to the questions that primary care colleagues are now asking, particularly around steroid use as Covid-19 cases continue to rise.

Now, more than ever, it is essential we ensure patients with asthma and COPD are managed according to the latest clinical guidance. The pragmatic guidance on this topic will be continuously reviewed and updated as the situation in the UK evolves and our knowledge and understanding of this global pandemic increases. We welcome feedback on what we are saying as we rely on our wider community to keep our opinion current and relevant.

Asthma

For patients with asthma, regular preventer ICS use remains central to the effective management of their condition. When taken as prescribed, ICS will reduce the risk of an asthma attack being triggered by a respiratory virus such as Covid19. For patients presenting with an asthma attack, the shortest duration of increased ICS or oral corticosteroids to gain control of the asthma attack should be used. There is currently no evidence that ICS increase the risks associated with Covid-19 infection at the present time. See guidance from Asthma UK on managing asthma during the Covid-19 epidemic.

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 high dose ICS in people with COPD the diagnosis should be reviewed. You should also 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.

You can now access the guidance as well as our dedicated Covid-19 webpage for the latest information advice and helpful links.