COVID-19 rapid guideline: managing symptoms (including at the end of life) in the community NICE guideline [NG163]

NICE has advised that its recommendations in its guidance on managing symptoms, including at the end of life, will be regularly updated.

The guideline advises GPs that older patients or those with comorbidities, frailty, impaired immunity or a reduced ability to cough and clear secretions are more likely to develop severe pneumonia.

Adults with a cough should be advised to use non-drug measures, such as a teaspoon of honey, to manage symptoms. However, if the cough is distressing, GPs could consider prescribing short-term codeine linctus or codeine phosphate tablets firstline. Morphine sulphate oral solution could be considered as a second choice.

Patients with fever should be advised to use paracetamol as opposed to an NSAID, the guidance says. It says that patients are most likely to experience fever five days after exposure to the infection.

Patients experiencing breathlessness should be advised to keep the room cool, open windows to improve air circulation and NICE also sets out a series of breathing techniques that could help patients manage their symptoms.

If oxygen is available, clinicians could consider a trial of oxygen therapy to assess if breathlessness improves.

NICE advises GPs to consider an opioid and benzodiazepine combination for patients with COVID-19 at the end of life and who have moderate to severe breathlessness and are distressed.

Usual guidance around taking into account waste, medicine shortages and lack of administration equipment are advised when GPs are prescribing and supplying anticipatory medicines at the end of life. However, the guidance says that if fewer health and care staff are available, GPs may need to prescribe subcutaneous, rectal or long-acting formulations for carers or family members to administer.