2 Treatment and care planning
2.1 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. This includes those with COVID‑19, or who are suspected of having it. Keep their self-management plan up to date, and remind them that online video resources on correct inhaler technique are available.
2.2 At every interaction with a patient, be alert for new or increased issues with mental health and wellbeing, particularly anxiety and depression.
2.3 Find out if patients have advance care plans or advance decisions around ceilings of care, including 'do not attempt cardiopulmonary resuscitation' decisions.
2.4 Encourage patients with more severe COPD who do not have advance care plans to develop one. Use decision support tools (when available), and refer to the Mental Capacity Act 2005 for patients who may lack capacity. Bear in mind that these discussions may need to take place remotely (see recommendation 1.5). Document discussions and decisions clearly and take account of these in planning care.
2.5 Explain to patients there is no evidence that treatment with inhaled corticosteroids (ICS) for COPD increases the risk associated with COVID‑19.
2.6 Tell patients established on ICS to continue to use them, and delay any planned trials of withdrawal of ICS. While there is some evidence that use of ICS in COPD may increase the overall risk of pneumonia (see the 2014 MHRA drug safety update on inhaled corticosteroids: pneumonia), do not use this risk alone as a reason to change treatment in those established on ICS and risk destabilising COPD management.
2.7 Tell patients on long-term oral corticosteroids that they should continue to take them at their prescribed dose, because stopping them can be harmful. Advise patients to carry a Steroid Treatment Card.
2.8 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.
2.9 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.
2.10 Do not offer patients with COPD a short course of oral corticosteroids and/or antibiotics to keep at home unless clinically indicated, as set out in the NICE guideline on chronic obstructive pulmonary disease in over 16s.
2.11 Strongly encourage patients with COPD who are still smoking to stop, to reduce the risk of poor outcomes from COVID‑19 and their risk of acute exacerbations. This could involve telephone, video or email consultation support (see NHS Stop smoking services help you quit). Ensure evidence-based interventions are available (see the NICE guideline on stop smoking interventions and services).
2.12 Use online pulmonary rehabilitation resources, such as those available in the British Thoracic Society pulmonary rehabilitation resource pack. This covers self-management, home exercise and educational materials.
2.13 Advise patients currently receiving long-term oxygen therapy not to adjust their oxygen flow rate, unless advised to by their healthcare professional.
2.14 Advise patients currently receiving ambulatory oxygen to continue to use it as prescribed and not to start using it at rest.
2.15 Do not routinely start prophylactic antibiotics to reduce risk from COVID‑19.
2.16 Tell patients already prescribed prophylactic antibiotics to continue taking them as prescribed, unless there is a new reason to stop treatment (for example, side effects or allergic reaction). Advise patients to contact their care team if this happens.
2.17 Advise patients currently using airway clearance techniques to continue to do so.
2.18 Advise patients that inducing sputum is a potentially infectious aerosol generating procedure, and they should take appropriate precautions such as:
performing airway clearance techniques in a well-ventilated room
performing airway clearance techniques away from other family members if possible
advising other family members not to enter the room until enough time has passed for aerosols to clear.
Find out more from UK government guidance on COVID-19: infection prevention and control.