This article focuses on :
- Communicating with patients and minimising risk
- Patients having biological treatment
- Patients starting biological treatment
- Modifications to usual care
Detailed summary :
1.Communicating with patients and minimising risk
- Communicate with patients, their families and carers, and support their mental wellbeing, signposting to charities to help alleviate any anxiety and fear they may have about COVID-19.
- Be aware that severe asthma is defined as asthma that requires treatment with highdose of inhaled corticosteroids plus a second controller to prevent it from becoming ‘uncontrolled’, or which remains ‘uncontrolled’ despite this therapy.
- Parents or carers of patients with severe asthma should be advised to follow shielding in UK government
- Patients, or their parent or carer should be dvised to continue taking their regular medicines in line with their personalised asthma action plan.
- Face-to-face contact should be minimised by:
- offering telephone, video or email consultations whenever possible
- cutting non-essential face-to-face appointments
- contacting patients by text message or email
- using alternative ways to deliver prescriptions and medicines, such as postal services, NHS volunteers, or drive through pick-up points.
- If patients are having a face-to-face appointment, on the day of the appointment , they should be screened first by telephone to make sure they have not developed symptoms of COVID-19.
- Patients should be asked to attend appointments with no more than 1 family member or carer, or alone.
- Minimise time in the waiting area by:
- careful scheduling
- encouraging patients not to arrive early
- texting patients when you are ready to see them
- When patients with known or suspected COVID-19 have been identified, infection prevention and control should be followed. This includes recommendations on using personal protective equipment (PPE), patient transfers, transport and options for outpatient settings.
- Carry out only bronchoscopy and pulmonary function tests for urgent cases.
Patients having biological treatment
- Patients, or their parent or carer, should be advised to continue treatment because there is no evidence that biological therapies for asthma suppress immunity.
- If the patient can be trained to self-administer, they could be treated at a community clinic or at home.
- Routine monitoring of biological treatment should be carried out remotely if possible.
Patients starting biological treatment
- When patients start on a new biological treatment, the risks and benefits of treatment should be balanced and service modifications should be taken into account.
- Start treatment even if:
- you’re not able to assess adherence to regular treatment in the usual way
- a multidisciplinary team discussion is not possible; 2 senior clinicians in the commissioned service, or delegated by the commissioned service, may make the decision to start biological treatment.
- Make sure that:
- the patient initiation form on Blueteq is completed; for continuation and annual review forms, make sure forms are completed at a future date
- patient data are added to the registry at the earliest opportunity, after getting patient consent; this can be deferred but, if it is, make arrangements to complete it at a future date.
- Have arrangements in place to enable patient self-administration or homecare for subsequent doses, to reduce the need for patients to come into hospital for treatment.
- Inhaled corticosteroids should be continued because stopping can increase the risk of asthma exacerbation.
- Patients on maintenance oral corticosteroids should continue to take them at their prescribed dose because stopping them can be harmful.
- Tell patients, or their parent or carer, that if they develop symptoms and signs of an asthma exacerbation, they should follow their personalised asthma action plan and start a course of oral corticosteroids if clinically indicated.
- Patients, or their parent or carer should be advised to wash their hands and clean equipment such as face masks, mouth pieces, spacers and peak flow meters regularly using a detergent.
- They should not share their inhalers and devices with anyone else.
- They should be advised to continue using their nebuliser.
Modifications to usual care
- Local policies should address modifying usual care at an organisational level.
- Outpatient waiting areas should be organised so that patients can continue social distancing from other patients and from clinic administrative staff.
- Enough asthma medicines should be prescribed to meet the patient’s clinical needs for no more than 30 days’ treatment.
Reference Link : https://www.nice.org.uk/guidance/ng166