We are aware that you are working under very difficult conditions at the moment with patients who may feel extremely anxious about COVID-19 and the potential impact it may have on them. This is not helped by some of the misinformation that is being spread across social media, making a complex situation even more challenging. In reality, the information we have about coronavirus is limited, and evidence is being gathered all the time in rapidly evolving circumstances about how it behaves.
We have trawled the internet for reliable sources of information and have added links to this statement so you can keep up to date as we become more knowledgeable about the virus and the illness. Here is a summary of what we have seen:
It is true that people who are old and/or have comorbidities are at increased risk of dying from COVID-19 yet despite this, most people with lung conditions experience mild symptoms only and will fully recover. Continuing with normal medication is key at present.
There are some problems with accessing supplies but these should be temporary and have in the main resulted from panic prescribing of large numbers of inhalers – a bit like the toilet roll/pasta situation. It is essential that clinicians stick to their normal prescribing practices to ensure that supplies meet demand. There is currently no issue with providing enough inhalers to meet the normal level of demand, even when inhalers are made and transported from abroad.
This is perhaps, the most controversial area, as many people will have been told to have a rescue pack ready for worsening symptoms, whereas others will have been told that oral steroids will make COVID-19 worse. ERS states that there is no evidence that prednisolone can make COVID-19 worse and the World Health Organization says that steroids should still be used for people with COPD who have a COVID-19 related flare up. BTS states that oral steroids should be used in acute asthma in the usual way and should not be withheld.
Current asthma treatment should be continued and no changes are necessary. No-one should need to step up treatment because of the current situation. ERS says that Anti-IL-5 should have no effect on the risk of getting COVID-19, and continuing on it could theoretically reduce the risk of an asthma attack if infected with the virus. Asthma UK has produced some detailed information for patients which can be found here: https://www.asthma.org.uk/advice/triggers/coronavirus-covid-19/. There is currently some debate about all patients who have been admitted in the past year needing to be shielded, as suggested in this document, particularly if their admission was many months ago and led to better asthma management and control. Each case should be assessed individually.
The recommendation is that current therapy should be continued and that antibiotics and oral steroids should be used in the same way that they normally would for exacerbations (see above). However, the advice on bronchiectasis management (below) points out that antibiotics will not work against viral infections. The NICE antimicrobial guidance on acute exacerbations of COPD recommends caution in prescribing antibiotics. It may be that sputum colour and amount should guide the use of antibiotic therapy, further details can be found here.
People with bronchiectasis should ensure that airway clearance techniques are practised regularly, and more often in the event of an infection with coronavirus. Paracetamol can help with fever, but antibiotics will not work against the virus.
Other lung conditions
The ERS ‘FAQ’ page is generally reassuring about the risks for people with lung conditions but for more information go to this page: https://www.europeanlung.org/en/QA-covid-19
Mental health can impact on respiratory conditions such as asthma and this link may be helpful: https://www.mentalhealth.org.uk/publications/looking-after-your-mental-health-during-coronavirus-outbreak
Gov.uk link for vulnerable people to register for assistance: https://www.gov.uk/coronavirus-extremely-vulnerable