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New: @NICEComms COVID-19 rapid guideline: community-based care of patients with chronic obstructive pulmonary disease (COPD). A thread:
https://www.nice.org.uk/guidance/ng168 ">https://www.nice.org.uk/guidance/... @lunguk @BTSrespiratory #COVID19 1/n
https://www.nice.org.uk/guidance/ng168 ">https://www.nice.org.uk/guidance/... @lunguk @BTSrespiratory #COVID19 1/n
Explain to patients with COPD and their families and carers, that they are at increased risk of severe illness from COVID‑19. 2/n
Be aware that @NICEComms guidance defines severe airflow obstruction in patients with COPD as an FEV1 <50% predicted. https://www.nice.org.uk/guidance/ng115/chapter/Recommendations">https://www.nice.org.uk/guidance/... 3/n
Other factors associated with a worse prognosis in people 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. 4/n
•past history of hospital admission
•need for long-term oxygen therapy or non-invasive ventilation
•limiting breathlessness
•the presence of frailty and multimorbidity. 4/n
Tell 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. 5/n
Be alert for new or increased issues with mental health and wellbeing, particularly anxiety and depression. 6/n
Find out if patients have advance care plans or advance decisions around ceilings of care, including & #39;do not attempt cardiopulmonary resuscitation& #39; decisions.
Encourage patients with more severe COPD who do not have advance care plans to develop one. 7/n
Encourage patients with more severe COPD who do not have advance care plans to develop one. 7/n
There is no evidence that treatment with inhaled corticosteroids (ICS) for COPD increases the risk associated with COVID‑19. 8/n
Tell patients that if they think they are having an exacerbation, they should follow their individualised COPD self-management plan and start a course of oral corticosteroids and/or antibiotics if clinically indicated. 9/n
Tell patients not to start a short course of oral corticosteroids and/or antibiotics for symptoms of COVID‑19, for example fever, dry cough or myalgia. 10/n
Strongly encourage smoking cessation, to reduce the risk from COVID‑19 and the risk of acute exacerbations. https://www.nhs.uk/live-well/quit-smoking/nhs-stop-smoking-services-help-you-quit/
Ensure">https://www.nhs.uk/live-well... evidence-based interventions including pharmacotherapy (e.g NRT, varenicline) are available 11/n #QuitforCovid
Ensure">https://www.nhs.uk/live-well... evidence-based interventions including pharmacotherapy (e.g NRT, varenicline) are available 11/n #QuitforCovid
Use online pulmonary rehabilitation resources, such as those available in the @BTSrespiratory pulmonary rehabilitation resource pack. https://www.brit-thoracic.org.uk/about-us/covid-19-information-for-the-respiratory-community/">https://www.brit-thoracic.org.uk/about-us/... This covers self-management, home exercise and educational materials. 12/n
Do not routinely start prophylactic antibiotics to reduce risk from COVID‑19. 13/n
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 they should take appropriate precautions. 14/n
Advise patients that inducing sputum is a potentially infectious aerosol generating procedure, and they should take appropriate precautions. 14/n
