COVID-19 NICE Guidance - managing COPD in the community
The purpose of this guideline is to maximise the safety of patients with Chronic Obstructive Pulmonary Disease (COPD) during the COVID-19 pandemic, while protecting staff from infection.
1. Communicating with patients and minimising risk
- Communicate with patients, their families and carers, and support their mental health and wellbeing to help alleviate any anxiety and fear that they may have about COVID-19. Signpost to charities such as the British Lung Foundation
- Explain to patients with COPD and their families and carers, that they are increased risk of severe illness from COVID-19
- Be aware that the NICE guidance on COPD defines severe airflow obstruction in patients with COPD as those who have an FEV1 less than 50% of predicted
- Other factors associated with a worse prognosis in patients with COPD include:
- Past history of hospital admission
- Need for long-term oxygen therapy or non-invasive ventilation
- Limiting breathlessness
- The presence of frailty and multimorbidity
- Some patients with severe COPD will have received a letter telling them they are at very high risk of severe illness from COVID-19
- Minimise face-to-face contact tor educe the risk of infection
- When patients with known or suspected COVID-19 have been identified follow appropriate UK government guidance
- If a patient has symptoms of COVID-19 on presentation or admission follow UK government guidance
2. Treatment and care planning
- Inform all patients to continue taking their regular inhaled and oral medicines in line with their individualised COPD self-management plan to ensure their COPD is as stable as possible.
- At every interaction with a patient, be alert for new or increased issues with mental health and wellbeing, particularly anxiety and depressions
- Find out if patients have advanced care plans or advance decisions around ceilings of care, including DNACPR
- Encourage patients with more severe COPD who do not have advance care plans to develop on. Use decision support tools and bear in mind that these discussions may need to take place remotely. Document discussions and decisions
- Explain to patients that there is no evidence that treatment with inhaled corticosteroids for COPD increases the risk associated with COVID-19
- Inform patients established on inhaled corticosteroids to continue to use them
- Inform patients on long-term oral corticosteroids that they should continue to take them at their prescribed dose because stopping them can be harmful.
- Advise patients currently receiving long-term oxygen therapy not to adjust their oxygen flow rate
- Do not routinely start prophylactic antibiotics to reduce risk from COVID-19
- Advise patients currently using airway clearance techniques to continue to do so
- Advise patients that inducing sputum is a potentially infectious aerosol generating procedure and that they should take precautions:
- Performing airway clearance techniques in a well-ventilated room
- Performing airway clearance techniques away from other family members if possible
- Advising other family members not to enter the room until enough time has passed for aerosols to clear.
- Inform patients to wash their hands and clean equipment such as face masks, mouth pieces, spacer devices and peak flow meters, regularly using washing-up liquid or following the manufacturers cleaning instructions
- Inform patients not to share their inhalers and devices with anyone else
- Inform patients 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.
- Do not offer nebulisers to patients unless clinically indicated
- Advise patients currently receiving non-invasive ventilation at home that these are potentially infectious aerosol generating procedures, and they should take the appropriate precautions such as:
- Use equipment in a well-ventilated room
- Using equipment away from other family members if possible.