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Covid-19 Primary Care Resources

Asthma – managing exacerbations

Rescue packs, distinguishing asthma from Covid-19 and use of inhaled and oral steroids

This information is sourced from the British Thoracic Society the Primary Care Respiratory Society and the BMJ:

Rescue packs:

  • There is no evidence to suggest that either antibiotics or corticosteroids are useful in the early stages of Covid-19 infection
  • Their use may delay patients seeking advice if they become increasingly short of breath
  • People with exacerbation action plans that include the use of rescue packs should have adequate supplies
  • Do not put rescue packs on repeat prescription
  • Every attack needs a review before adjusting any treatment plan

Distinguishing an asthma attack from Covid-19:

Use of Inhaled Corticosteroids (ICS) in an asthma attack possibly triggered by Covid 19:

  • The risk of inadequately treating an asthma attack is highly likely to be worse than the risk from Covid-19
  • Current evidence supports up to quadrupling ICS from standard doses until symptoms improve in adults
  • Evidence does not support increasing ICS in children in asthma to improve asthma attack outcomes

Use of Oral Corticosteroids (OCS) in an asthma attack possibly triggered by Covid-19:

  • There is no evidence to suggest appropriate use of OCS in asthma attacks will cause a worse outcome if Covid 19 or similar viruses is suspected to be the trigger
  • The important factor is to stop the OCS once symptoms improve (and for there to be clarity in the action plan about what this looks like) so they receive the minimum amount necessary and to have clear follow up and review pathways

Follow-up and safety-netting:

  • All patients with moderate symptoms should be followed up via remote assessment within 24 hours
  • Asthma attacks requiring hospital admission tend to develop relatively slowly over 6-48 hours
  • However, deterioration can be more rapid, and symptoms can worsen overnight. Patients should be advised to look out for any worsening breathing or wheeze, lack of response to their inhalers, or worsening PEF
  • They should receive clear advice on what to do, including use of their reliever, and who to contact
  • They should be advised to have a low threshold to call 999 if their symptoms deteriorate
  • If Covid-19 infection is also suspected, advise them to isolate for seven days from onset of symptoms and arrange testing