COVID-19 rapid guideline: severe asthma

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Salient features:

This article focuses on :

    • Communicating with patients and minimising risk
    • Investigations
    • Treatment 
      • Patients having biological treatment
      • Patients starting biological treatment
      • Corticosteroids 
    • Equipment
    • 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.  

2.Investigations 

  • Carry out  only bronchoscopy and pulmonary function tests for urgent cases.

3.Treatment

 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.   

Corticosteroids 

  • 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. 

Equipment 

  • 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

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