Guidance for respiratory patients from PCRS during COVID-19
BTS and Primary Care Respiratory Society consensus guide
For patients with asthma, current guidelines recommend that all patients with asthma should be on an ICS except those who use <3 doses of SABA per week on average over the year. People with asthma must continue their preventive ICS according to current guidelines. There is no evidence of a relationship between the use of ICS and COVID-19 infection at present and ICS. When taken as prescribed, ICS will reduce the risk of an asthma attack being triggered by a respiratory virus such as Covid 19. For patients presenting with an asthma attack, current evidence supports up to quadrupling ICS from standard doses until symptoms improve in adults. Evidence does not support increasing ICS in children in asthma to improve asthma attack outcomes. Oral corticosteroids (OCS) should be used in people with asthma attacks according to current UK guidelines.
Prescribing of high dose ICS in people with COPD for the prevention of exacerbations has always needed to be clearly justified and the current situation should concentrate our minds further on ICS safety in COPD. Before prescribing high dose ICS in people with COPD the diagnosis should be reviewed including their history of blood eosinophil elevations. If you are not confident of their diagnosis of COPD and/or you are not able to record clear asthmatic features or blood eosinophil counts >0.3 or high exacerbation counts, then the patient should not be on a long-term ICS. If they are on high dose ICS, consider reducing this to a standard dose. ICS can be used in people with presenting with COPD exacerbation if it is possible Covid 19 is triggering it, but should not be given if the patient has a high temperature. Additionally, for those who do not have a high blood eosinophil count or a history of steroid reversibility – steroids should be withheld if the patient has a severe infection.
Should all people with asthma and COPD be issued with rescue packs?
At the present time there is no evidence to suggest that either antibiotics or corticosteroids are useful or appropriate in the early stages of Covid 19 infection and their use may delay patients seeking advice if they become increasingly short of breath. People with exacerbation action plans developed through shared decision making that include the use of rescue packs should ensure they have adequate supplies to follow the agreed plan. Do not put rescue packs on repeat prescription. Every attack needs a review to understand why before adjusting any treatment plan.