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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 @lunguk @BTSrespiratory #COVID19 1/n
https://www.nice.org.uk/guidance/ng168 @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 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 'do not attempt cardiopulmonary resuscitation' 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 evidence-based interventions including pharmacotherapy (e.g NRT, varenicline) are available 11/n #QuitforCovid
Ensure 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/ 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
