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Covid-19 Primary Care Resources


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