COVID-19 NICE Guidance - Adults and children with severe asthma

The purpose of this guideline is to maximise the safety of adults and children with severe asthma during the COVID-19 pandemic, while protecting staff from infection.

      1. Communicating with patients and minimising risk

• Communicate with patients and their families and carers and support their mental wellbeing, signpost to charities
• Be aware that severe asthma is defined by the ERS and ATS as asthma that requires treatment with high-dose inhaled corticosteroids, plus a second controller to prevent it from becoming ‘uncontrolled’, or which remains ‘uncontrolled’ despite therapy
• Some patients with severe asthma will receive a letter telling them they are at high risk of severe illness from COVID-19. Tell them or their parent or carer to follow the advice on shielding.
• Inform all patients, or their parent or carer, to continue taking their regular medicines in line with their personalised asthma action plan. This includes those with COVID-19, or suspected of having it.
• Minimise face-to-face contact
• Ask patients to attend appointments with no more than 1 family member of carer, or alone if they can.
• When patients with known or suspected COVID-19 have been identified, follow appropriate government guidance.

      2. Treatment

• Patients having biological treatment
• Inform patients, or their parent or carer, that they should continue treatment because there is no evidence that biological therapies for asthma suppress immunity
• If the patient usually attends hospital to have biological treatments, think about if they ca be trained to self-administer, or could be treated at a community clinic or at home
• Carry out routine monitoring of biological treatment remotely if possible
• Patients starting biological treatment
• When patient start on a new biological treatment, balance the risks and benefits of treatment, and take into account service modifications
• Start treatment even if you are not able to assess adherence to regular treatment in the usual way. For more information visit the full guidance
• Corticosteroids
• Inform patients, or their parent or carer, to continue using inhaled corticosteroids because stopping can increase the risk of asthma exacerbation.
• Inform patients on maintenance oral corticosteroids, or their parent or carer to continue to take them at their perceived dose because stopping them can be harmful
• Inform patients, or their parents or carer, that if they develop symptoms and signs of an asthma exacerbation, they should follow their personalise asthma action plan and start a course of oral corticosteroids if clinically indicated.
  

  
  3. Equipment

• Inform patients, or their parent or carer, to wash their hands and clean equipment such as face masks, mouth pieces, spacers and peak-flow meters regularly using a detergent (for example washing up liquid), or to follow the manufacturers cleaning instructions
• Inform patients, or their parent or carer, not to share their inhalers and devices with anyone else
• Inform patients, or their parent or carer, they can continue to use their nebuliser, this is because the aerosol comes from the fluid in the nebuliser chamber and will not carry virus particles from the patient.