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GPs should monitor cystic fibrosis patients ‘closely’ during pandemic, says NICE



GPs should monitor patients with cystic fibrosis ‘closely’ during the coronavirus (Covid-19) pandemic, a new rapid guideline from NICE has said.

The guideline on managing cystic fibrosis during the pandemic said that these patients ‘may be at greater risk of rapid deterioration if they contract Covid-19’.

GPs should tell patients to take ‘rescue medication’ and contact their cystic fibrosis team if they have an exacerbation, following any previous advice, it added.

It said: ‘Tell patients, their families and carers to follow the advice they have previously been given about what to do if they have an exacerbation, including taking rescue medication and contacting their cystic fibrosis team.’

Patients, their families and their carers should also be advised to contact their cystic fibrosis team as well as NHS 111 if they think the patient may have coronavirus as soon as symptoms appear, NICE said.

It added: ‘Be aware that symptoms of Covid‑19 and pulmonary disease exacerbations may be difficult to differentiate at initial presentation.’

GPs should advise patients with cystic fibrosis to continue any usual self-care arrangement such as airway clearance techniques and prophylactic medication including inhaled and oral antibiotics, NICE said.

The guideline added that although GPs should minimise face-to-face contact to reduce the risk of infection to patients with cystic fibrosis – who should follow shielding guidelines – ‘routine’ childhood vaccinations should ‘continue to take place’ at practices.

Highlights from NICE’s new Covid-19 rapid guideline on cystic fibrosis

  • Tell patients, their families and carers to follow relevant parts of UK government guidance on shielding and protecting people defined on medical grounds as extremely vulnerable from Covid-19, until the risks associated with the Covid‑19 pandemic have passed. 
  • Monitor patients with cystic fibrosis closely, because they may be at greater risk of rapid deterioration if they contract Covid‑19.
  • Minimise face-to-face contact to reduce the risk of infection. However, note that routine childhood vaccinations should continue to take place at the GP surgery.
  • Tell patients, their families and carers that they should contact their cystic fibrosis team if they think the patient may have Covid‑19, to ensure that their symptoms are appropriately assessed. They should do this as soon as they have symptoms. They should also contact the NHS 111 online coronavirus service or call NHS 111. In an emergency they should call 999 if the patient is seriously ill.
  • Be aware that symptoms of Covid‑19 and pulmonary disease exacerbations may be difficult to differentiate at initial presentation.
  • Tell patients, their families and carers to follow the advice they have previously been given about what to do if they have an exacerbation, including taking rescue medication and contacting their cystic fibrosis team.
  • Tell patients, their families and carers to continue with all their usual self-care arrangements including, for example:

Source: NICE