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Covid-19 Primary Care Resources


Severe asthma



Defining severe asthma and how to review treatment in the context of Covid-19

This information is sourced from NICE and the British Thoracic Society (BTS):

Definition:

The NICE COVID-19 rapid guideline: severe asthma states:

Severe asthma is defined by the European Respiratory Society and American Thoracic Society as asthma that requires treatment with high-dose inhaled corticosteroids, plus a second controller (and/or systemic corticosteroids) to prevent it from becoming ‘uncontrolled’, or which remains ‘uncontrolled’ despite this therapy

The BTS has noted that patients with severe asthma on biologics were not included in the intitial CMO criteria but should also be advised to shield

Treatment:

  • Patients having biological treatment should continue treatment because there is no evidence that biological therapies for asthma suppress immunity
  • Continue using inhaled corticosteroids because stopping can increase the risk of asthma exacerbation
  • If a patient develop symptoms and signs of an asthma exacerbation, they should follow their personalised asthma action plan and start a course of oral corticosteroids if clinically indicated

Equipment:

  • Tell patients to wash their hands and clean equipment such as face masks, mouth pieces, spacers and peak flow meters regularly using a detergent (for example, washing-up liquid), or to follow the manufacturer’s cleaning instructions
  • Do not to share their inhalers and devices with anyone else
  • They can continue to use their nebuliser. This is because the aerosol comes from the fluid in the nebuliser chamber and will not carry virus particles from the patient

This information is sourced from the British Thoracic Society:

For patients on maintenance oral corticosteroids:

They should continue to take them at their prescribed dose as stopping steroids suddenly can be harmful

It is worth reiterating the “sick day rules” and reminding patients that if they become unwell (for any other reason) they need to increase their steroid dose appropriately (usually doubled)

See also: Long term condition reviews

Sources

Published: 03/04/2020

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Published: 07/04/2020