NICE publishes further rapid COVID-19 guidance for patients with respiratory and skin conditions

The latest set of guidance covers the management of patients with COPD, cystic fibrosis, and dermatological conditions treated with immunomodulatory drugs.

Oxygen follow-up assessments can be postponed in patients with COPD to reduce the risk of COVID-19 infection, NICE says. | GETTY IMAGES
Oxygen follow-up assessments can be postponed in patients with COPD to reduce the risk of COVID-19 infection, NICE says. | GETTY IMAGES

NICE's rapid COVID-19 guidance is intended to maximise the safety of patients and make best use of NHS resources, while protecting staff from infection. The first set of guidance, published last week, covers management of COVID-19 in the community, as well as care of patients with severe asthma and those with rheumatological disorders.

Managing COPD

The new guidance on community-based care of patients with COPD says all patients, including those with suspected or confirmed COVID-19, should continue taking their regular inhaled and oral medicines in line with their individualised self-management plan.

Healthcare professionals should prescribe enough COPD medicines to meet the patient's clinical needs for no more than 30 days, NICE emphasises, as prescribing larger quantities of medicines 'puts the supply chain at risk'.

NICE says there is no evidence that treatment with inhaled corticosteroids for COPD increases the risk associated with COVID-19, so patients established on these drugs should continue to use them, and delay any planned trials of withdrawal. Patients on long-term oral corticosteroids should also be told to continue taking them at the prescribed dose.

If patients think they are having an exacerbation, they should be advised to follow their self-management plan and start a course of oral corticosteroids and/or antibiotics if clinically indicated. They should not start a short course of oral corticosteroids and/or antibiotics for symptoms of COVID-19, for example fever, dry cough or myalgia.

The guidance says prescribers should not offer patients with COPD a short course of oral corticosteroids and/or antibiotics to keep at home 'unless clinically indicated'.

Patients receiving long-term oxygen therapy should not adjust their oxygen flow rate unless advised to by a healthcare professional. Patients receiving ambulatory oxygen should be advised not to start using it at rest or in their home.

The guidance says healthcare professionals should find out if patients have advance care plans and encourage those with severe COPD to develop one if not. These discussions may need to take place remotely, NICE adds.

Patients with COPD who are still smoking should be strongly encouraged to stop and provided with support and evidence-based interventions as needed.

NICE also advises prescribers to be alert at every interaction with patients for new or worsening issues with mental health and wellbeing.

Patients with COPD who think they have COVID-19 should be advised to contact NHS 111 online coronavirus service or call NHS 111.

Cystic fibrosis

NICE's guidance on cystic fibrosis makes clear that patients should continue with all their usual self care arrangements, including medication and exercising at home.

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

If the patient thinks they may have COVID-19, they should contact their cystic fibrosis team.

NICE recommends that patients with symptoms of COVID-19 perform airway clearance techniques in a well ventilated room, ideally away from other family members if possible.

Skin conditions

NICE's guidance on dermatological conditions treated with drugs affecting the immune response says that patients known or suspected to have COVID-19 should continue topical treatments, and that topical rather than systemic treatments should be considered for any new skin conditions.

Oral corticosteroids should not be suddenly stopped. Hydroxychloroquine, chloroquine, mepacrine, dapsone and sulfasalazine should also be continued, but prescribers may consider temporarily stopping other immunological treatments.

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.

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