NG166 - COVID-19 rapid guideline: severe asthma

The COVID-19 rapid guideline on severe asthma says that all patients should continue to take their medication in line with their asthma action plan, including those who have confirmed or suspected COVID-19.

If a patient needs to be seen they should be screened via telephone to assess whether they have symptoms of COVID-19 ahead of the appointment. GPs should follow guidance on infection prevention and control when seeing patients.

GPs should only prescribe asthma medications to meet the patient’s clinical needs and for no more than 30 days, otherwise the supply chain for medication could be put at risk, the guidance says

Pulmonary function tests should only be carried out for urgent cases and if the results will have a direct impact on how the patient is treated, the guidance says, because the tests have the potential to spread the virus.

Patients should also be advised to regularly clean all of their equipment using a detergent, such as washing up liquid, and not to share their devices with anyone else. If patients are using a nebuliser, they can continue to use this because this does not carry virus particles from the patient to anyone else.

GPs should also signpost patients to charities, such as Asthma UK and the British Lung Foundation, if they have any anxieties about COVID-19 and they should be advised to follow advice about social distancing and shielding if they fall into this group.

Rheumatological disorders

GPs should be aware that patients having immunosuppressant treatments may have atypical presentations of COVID-19, according to NICE’s rapid guideline on rheumatological autoimmune, inflammatory and metabolic bone disorders.

The guidance highlights the examples of patients taking prednisolone who may not develop a fever, and those taking interleukin-6 inhibitors may not develop a rise in C-reactive protein.

NICE recommends that patients should contact their rheumatology team about any issues related to their medicines, or if their condition worsens. They should also be advised to follow advice about social distancing and shielding if they fall into this group.

NICE said future guidelines that will form part of the rapid COVID-19 recommendations were likely to cover COPD, cystic fibrosis and people receiving immunotherapy.