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Covid-19 Primary Care Resources


COPD



Clinical criteria for severe COPD, medication reviews and rescue packs

This information is sourced from NHSE, the Primary Care Respiratory Society (PCRS)NHS London clinical networks and NICE:

Clinical Criteria

This information is sourced from NHSE:

The clinical criteria for severe COPD is those patient’s prescribed “triple therapy” inhalers (LABA + LAMA + ICS) and/or roflumilast

Reviewing Inhaled Corticosteroids (ICS) in COPD patients

  • Patients should not be on a long-term ICS unless there is a record of clear asthmatic features or blood eosinophil counts >0.3 or high exacerbation counts
  • Tell patients established on ICS to continue to use them, and delay any planned trials of withdrawal of ICS
  • Explain to patients there is no evidence that treatment with inhaled corticosteroids (ICS) for COPD increases the risk associated with Covid‑19
  • While there is some evidence that use of ICS in COPD may increase the overall risk of pneumonia do not use this risk alone as a reason to change treatment in those established on ICS and risk destabilising COPD management

Rescue packs – be aware there is some variation in guidance

This information is sourced from the PCRS:

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

This information is sourced from NHS London clinical networks:

  • For COPD patients, unless contraindicated, prescribe a rescue pack and ensure it is delivered to them at home. Ensure this is not on a repeat prescription and ensure that the patient knows how & when to use this.

This information is sourced from NICE:

  • Do not offer patients with COPD a short course of oral corticosteroids and/or antibiotics to keep at home unless clinically indicated

See also: Long term condition reviews