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Covid-19 Primary Care Resources


IECOPD



Exacerbations, oral corticosteroid use, and interpreting oxygen saturations when unwell with Covid 19

This information is sourced from the Primary Care Respiratory Society (PCRS)NHS London Clinical Networks and NICE:

Interpreting oxygen saturation in cases of Covid 19 infection

This information is sourced from NHS London clinical networks:

  • Mild deterioration would be defined as up to 2% below their baseline O2 pulse oximetry sats
  • Moderate deterioration would be defined as between 3-4% below their baseline O2 pulse oximetry sats
  • Severe deterioration would be defined as 4% or more below their baseline O2 pulse oximetry sats

If on Long Term Oxygen Therapy (LTOT) discuss ceiling of care and consider admission if sats <88% on their standard dose of LTOT

COPD exacerbations

This information is sourced from the PCRS:

  • Exacerbations of COPD and pneumonia present with similar symptoms in people with COPD
  • The pneumonias we will see during this period will be Covid-19, bacterial, other viral or a combination
  • The early rapidly produced guides at the start of the pandemic were suggesting low thresholds for/prophylactic antibiotic use in suspected Covid-19 patients with higher risk of pneumonia
  • Colleagues are now reporting that the need for antibiotics is less than expected

The features more associated with pneumonia than AECOPD that you can determine from a video or telephone call are:

  • Cough producing greenish, yellow or even bloody mucus – a change from usual is key
  • Fever, sweating and shaking chills
  • Sharp or stabbing chest pain that gets worse with deeper breathing or coughing
  • Nausea and vomiting
  • Confusion

You should have a low threshold for considering further review with imaging and bloods. Rapid antibiotic therapy can be live saving

This information is sourced from NICE:

  • Tell patients not to start a short course of oral corticosteroids and/or antibiotics for symptoms of Covid‑19, for example fever, dry cough or myalgia

Oral Corticosteroid (OCS) use

This information is sourced from the PCRS:

  • OCS can be used but do not give if the patients has a high temperature, normal blood eosinophil count or without a history of steroid reversibility
  • When given, the course should be for as short a period as possible. NICE currently recommends 30mg prednisolone for 5 days

This information is sourced from NHS London clinical networks:

  • Where a patient with COPD develops increased cough or increased breathlessness in keeping with a previous exacerbation they should take their appropriate rescue medication
  • Oral corticosteroids can also be considered if known concomitant asthma and / or history of eosinophils ≥ 0.3 or known steroid responsiveness
  • Before prescribing steroids, ensure you are advising that the control of symptoms with increased bronchodilation, breathing exercises and pacing, for example and where appropriate
  • Oral corticosteroids should be avoided in Covid-19 suspected infection (fever or new cough that is different from usual)