1 Communicating with patients and minimising risk

1.1 Communicate with patients, their families and carers, and support their mental health and wellbeing to help alleviate any anxiety and fear they may have about COVID‑19. Signpost to charities (such as the British Lung Foundation) and support groups (such as NHS Volunteer Responders), and UK government guidance on the mental health and wellbeing aspects of COVID-19.

1.2 Explain to patients with chronic obstructive pulmonary disease (COPD), and their families and carers, that they are at increased risk of severe illness from COVID‑19.

1.3 Be aware that the NICE guideline on chronic obstructive pulmonary disease in over 16s 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.

1.4 Some patients with severe COPD will have received a letter telling them they are at very high risk of severe illness from COVID‑19. Tell them, or their families and carers, to follow UK government advice on shielding and protecting people defined on medical grounds as extremely vulnerable from COVID-19.

1.5 Minimise face-to-face contact to reduce the risk of infection by:

  • using telephone, video or email consultations whenever possible

  • cutting non-essential face-to-face appointments

  • contacting patients via text message, telephone or email

  • using electronic prescriptions rather than paper

  • using different methods to deliver prescriptions and medicines to patients, for example pharmacy deliveries, postal services, NHS Volunteer Responders or introducing drive-through pick-up points for medicines.

1.6 If patients are having a face-to-face appointment, on the day of the appointment first screen them by telephone to make sure they have not developed symptoms of COVID‑19.

1.7 Tell patients, their families and carers that they should contact NHS 111 online coronavirus service or call NHS 111 if they think they have COVID‑19. They should do this as soon as they have symptoms. In an emergency they should call 999 if they are seriously ill.

Patients not known to have COVID-19

1.8 If patients need to attend face-to-face appointments, ask them to go alone if they can, or with no more than 1 family member or carer, to reduce the risk of contracting or spreading infection with COVID‑19. They should avoid using public transport if possible.

1.9 Minimise time in the waiting area by:

  • careful scheduling to avoid several patients waiting at the same time

  • separate entrance and exit routes if possible to minimise contact

  • encouraging patients not to arrive early

  • texting or calling patients when you are ready to see them, so that they can wait in their car, for example.

Patients known or suspected to have COVID-19

1.10 When patients with known or suspected COVID‑19 have been identified, follow appropriate UK government guidance on infection prevention and control. This includes recommendations on using personal protective equipment (PPE), patient transfers, transport and options for outpatient settings.

1.11 If a patient has symptoms of COVID‑19 on presentation or admission, follow UK government guidance on investigation and initial clinical management of possible cases. This includes information on testing and isolating patients.

1.12 If COVID‑19 is later diagnosed in a patient not isolated from admission or presentation, follow UK government guidance for health professionals.