Patients with severe COPD should have advanced care plans, says NICE COVID-19 advice

GPs should encourage patients with severe COPD to develop advanced care plans, according to a new rapid COVID-19 clinical guideline produced by NICE.

Patients with COPD should continue to take their medication as normal (Photo: Terry Vine/Getty Images)
Patients with COPD should continue to take their medication as normal (Photo: Terry Vine/Getty Images)

The guidance on community-based care of patients with COPD, is part of a series of guidelines NICE is developing in response to the coronavirus pandemic.

NICE has also produced new guidance covering the ongoing care of patients with cystic fibrosis and those receiving immunotherapy for dermatological conditions. Last week it published guidance on managing COVID-19 in the community, plus management of patients with severe asthma and rheumatological disorders.

COPD guidance

NICE's new guideline on COPD advises GPs to 'find out if patients have advance care plans or advance decisions around ceilings of care, including "do not attempt cardiopulmonary resuscitation" decisions'. Patients with more severe COPD who do not have advanced care plans should be encouraged to develop them, NICE adds.

Face-to-face contact with COPD patients should be kept at a minimum, so much of this work will need to be done remotely, NICE advises.

GPs should advise patients not to take a course of corticosteroids or antibiotics if they develop symptoms of COVID-19, NICE also says. They should not provide patients with a short course of oral corticosteroids or antibiotics to keep at home 'unless this is clinically indicated'.

More generally, GPs should advise all patients to continue to take all medication in line with their COPD management plan, to ensure their condition is 'as stable as posisible' - this includes any patients   suspected of having COVID-19.

Patients should also follow their self-management plan if they think they are having an exacerbation. NICE says that there is no evidence that treatment with inhaled corticosteroids increases the risk associated with COVID-19.

Patients using airway clearance techniques should perform these in a well ventilated room, away from other family members if possible.

NICE also says that patients should only be prescribed medication for no more than 30 days to avoid putting the supply chain at risk.

Patients with COPD who are still smoking should be 'strongly encouraged' to quit in order to reduce the risk of poor outcomes from COVID-19 as well as the risk of exacerbations.

Meanwhile, COPD management plans should be kept up to date and GPs should 'be alert for new or increased issues with mental health and wellbeing' at every interaction with patients, NICE says.

Routine pulmonary function testing and oxygen follow up assessments could be deferred if possible, the guidance recommends.

Patients taking immunotherapy and those with cystic fibrosis

NICE's guidance on dermatological conditions treated with drugs affecting the immune response suggests that dermatology departments could only continue providing core services during the pandemic if necessary. It adds that trusts could consider providing acute and emergency dermatology advice to GPs to avoid unnecessary emergency department attendances, using 'tele-triage where possible'.

GPs should also be aware that patients taking drugs that affect the immune system may have atypical presentations of COVID-19. For example, the guidance highlights that patients taking prednisolone may not develop a fever.

Meanwhile, NICE's guidance on cystic fibrosis emphasises that patients should continue with all their usual self care arrangements, including medication and home exercise.

It adds that patients with cystic fibrosis should be monitored closely, 'because they may be at greater risk of rapid deterioration if they contract COVID-19'.

Patients should also follow advice they have been previously given about what to do if they have an exacerbation, including contacting their cystic fibrosis team.

NICE COVID-19 guidance

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