4 Modifications to usual care and service delivery
4.1 Make policy decisions about modifications to usual care at an organisational level.
4.2 When planning changes to usual care, take into account people's access to digital and online resources, digital literacy and any preference for verbal or written support (for example, digital-only services could lead to inequalities of access for people with limited internet access).
4.3 Think about how to modify usual care to reduce patient exposure to COVID‑19 and make best use of resources (workforce, facilities, equipment), for example:
switch respiratory services to telephone or virtual consultations, including routine annual reviews
defer routine pulmonary function testing
defer oxygen follow-up assessments if possible.
4.4 On a case-by-case basis, carry out or defer assessments to establish if patients are eligible for long-term oxygen therapy (as defined by the NICE guideline on chronic obstructive pulmonary disease in over 16s) or might benefit from non-invasive ventilation at home for nocturnal hypoventilation.
4.5 Prescribe enough COPD medicines to meet the patient's clinical needs for no more than 30 days. For inhalers this depends on the type of inhaler and the number of doses in the inhaler. Prescribing larger quantities of medicines puts the supply chain at risk.