COVID-19: Supporting Patients with COPD in Primary Care
Supporting patients with COPD in primary care during the COVID-19 pandemic through community respiratory support, remote self-management, and current guidance for health professionals. Learn about triaging acutely unwell patients, FAQs, and recommendations on use of the Roth Score for remote assessments.
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COVID-19: Supporting Patients with COPD in Primary Care Louise Goswell, Specialist Respiratory Physiotherapist, CPFT Deborah Watts, Specialist Respiratory Nurse, CPFT Hosted by: Kathryn Caley, GPN Education Facilitator, Training Hub 31th March 2020
Agenda Community Respiratory Support during COVID-19 Pandemic Current Guidance for Health Professionals regarding COPD and COVID-19 Supporting remote Self-Management (myCOPD app) Useful Links
Community Respiratory Team Support Have you triaged an acutely unwell COPD / Bronchiectasis or ILD patient? Does the patient require urgent input? If yes, Contact the Community Respiratory Team and speak to the oncall Respiratory Clinician on 07790 571092 for advice and guidance. Working Hours: Monday Sunday, 8 am 8 pm
FAQs Q: Is there anything you want to know before we call you? A: NHS number, brief medical history and reason for referral. Q: Who do we contact out of hours? A: Previous route Q: Will the patients get this number? A: No, the number is for health care professionals only Q: Do you cover Palliative Care and DNR planning? A: Yes. We will be working closely with the District Nurses who have more experience in this area.
FAQs Q: Should the Roth Score be used in Remote Assessment of patients with possible COVID-19 A: No. Please note this review of the evidence and advice in relation to the use of the Roth Score has been published since the meeting on 31st March. https://www.cebm.net/covid-19/roth-score-not-recommended-to- assess-breathlessness-over-the-phone/
Current Guidance for COPD and Covid-19 The majority of community respiratory services should be switched to telephone or virtual consultation Routine annual reviews should continue virtually to reassure patients and ensure they are happy with their management plans to avoid hospital attendance No Spirometry to be performed Careful distribution of inhalers to avoid stockpiling
Current Guidance for COPD and Covid-19 All patients that have rescue packs and are using them appropriately should have them reissued. No new packs should be issued because of the Covid-19 situation Treatment of COPD exacerbation is 5 days treatment as normal with antibiotics and steroids. Antibiotics and steroids not indicated for just Covid-19 symptoms. Anxiety and breathlessness management techniques Hand held fan not indicated with Covid-19
Current Guidance for COPD and Covid-19 Oxygen: for use in prevention of admission and supporting early discharge, no real place for this in end of life care in Covid-19 patients, treatment via syringe drivers or s/c. BOC home oxygen portal for ordering, can be delivered in 4 hours, need control on prescribing so no shortage. Preferably concentrators: a variety of modalaties. Cylinders probably not that useful. BOC limiting cylinder exchange. My Airvo (high flow humidified oxygen) not indicated for Covid-19, but will have a use in supporting early discharges from acute. Will need full PPE.
FAQs Q: Would you recommend Rescue Packs for all COPD patients? A: For patients who already have existing rescue packs and are using them appropriately they should continue with their supply. New rescue packs should not be issued to patients because of the Covid-19 situation Q: If your patient has suspected Covid-19, is it advisable to use Rescue Packs anyway for protection? A: No. If a patient with COPD has non respiratory symptoms only of Covid-19 (fever, fatigue, myalgia), there is no routine indication to take rescue antibiotics or additional oral steriods
FAQs Q: Should we be advising most at risk patients to purchase their own nebuliser unit? A: No. Good inhaler technique is more effective. And the use of spacers with MDI s. NB: As nebulisers are not viral droplet generating, normal PPE is sufficent. Q: Should we be advising most at risk patients to purchase their own Sats Probe? A: If possible, yes. (There may be a supply issue). They assist clinicians to make assessments over the phone. It also reduces the need for Community Respiratory team to take a pulse oximeter into the house and have to deal with the subsequent cleaning.
FAQs Q: Bronchiectasis is not on the list of people who need shielding. If they are bad, should they be shielded? A: Yes. We would recommend that patients who suffer from severe disease should be shielded. Q: Is there a way you would recommend to differentiate which Bronchiectasis patients should shield vs socially distance A: A crude measure would be to base it on exacerbation frequency. 3 - 4 antibiotic use in a year would indicate severe disease and a need to shield. Another indication is sputum volume but this normally correlates with exacerbation frequency.
FAQs Q: Most Practices are not offering gown and PP3 masks. What do you suggest? A: For patients with aerosol generating processes i.e. nasal ventilation and My Airvo (very high flow humidified oxygen), full protection is required: gown, PP3 mask, eye protection, gloves. NB: My Airvo is not indicated in Covid-19 patients, so full protection should only be required for nasal ventilation. For all other contacts within 2 metres: gloves, eye protection, apron and surgical mask are required.
FAQs Q: Fostair not in stock in Cambridge (as at 31.03.20). What are you advising? A: The CCG Medicines Optimisation Team are keeping their website updated with current stock shortages and recommended alternatives. Link: https://www.cambridgeshireandpeterboroughccg.nhs.uk/health- professionals/prescribing-information/current-stock-shortages/
Supporting Self Management (myCOPD) myCOPD is a comprehensive, user-friendly COPD app that can be used on any device to support patients to self manage and improve the quality of a remote consultation
FAQs Q: Is this app free to the patient? A: The CCG has purchased myCOPD licences so it is free if access is set up via their Health Care Professional (HCP). If they download it directly, there is a cost to them. Q: How does an HCP register to use myCOPD with their patients? A: Please send your name, email, profession and Practice name to E: candptraininghub@nhs.net marked myCOPD registration and FAO Kathryn Caley Q: Is the app GDPR compliant? A: Yes. This has been ratified via NHS England. Q: Is the app suitable for any device? A: Yes
Useful Links BTS guidance "COVID-19 Information for the Respiratory Community": https://www.brit-thoracic.org.uk/about-us/covid-19-information-for-the-respiratory- community/ Asthma UK "COVID-19 Health Advice for people with Asthma": https://www.asthma.org.uk/advice/triggers/coronavirus-covid-19/ Inhaler / Spacer Information: https://www.rightbreathe.com/ CCG guidance regarding current medicine stock shortages (incl inhalers): https://www.cambridgeshireandpeterboroughccg.nhs.uk/health-professionals/prescribing- information/current-stock-shortages/
Useful Links BLF Resources for patients: https://www.blf.org.uk/exercise-video Oxford COVID-19 Evidence Service: https://www.cebm.net/covid-19- evidence-service
