This pragmatic guide has been written to respond to the questions that primary care colleagues are now asking, particularly around steroid use as Covid 19 cases begin to rise. ** Updated 7th May**
Diagnosing and managing asthma attacks and people with COPD presenting in crisis during the UK Covid 19 epidemic
This pragmatic guide has been written to respond to the questions that primary care colleagues have been asking, initially around steroid use as Covid 19 cases began to rise but also more broadly for what this pandemic means for people living with asthma and COPD.
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. 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 upto quadrupling ICS from standard doses until symptoms improve in adults. Evidence does not support increasing ICS in children with 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 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, we would usually recommend that you consider reducing this to a standard dose and indeed stopping it if the evidence did not support continued use. However, we support the NICE Rapid COPD Review position to refrain from making changes to preventer therapy now and suggest waiting until this wave of Covid 19 illness is waning and a more normal way of working has resumed. OCS 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 or other evidence of a severe infection.