The Canadian thoracic society have produced position statements to guide management of COPD and asthma during the COVID pandemic.

Summary of Main Points

There is no data suggesting that the risk of becoming infected with SARS-CoV-2 is higher in patients with COPD or asthma. Patients with lung disease (COPD) are at higher risk of a more serious illness course. This should be factored into management and monitoring plans. Excellent control of both COPD and asthma are particularly important in keeping patients away from hospital (and its attendant risks for infection).

The CTS recommend against using nebulisers. See the full documents (COPD and Asthma) for guidance on switching and dose equivalents.

COPD

Physical Distancing

  • Maintain very strict home isolation and 30 day medication supply.

Routine care

  • There is no data indicating increased risk of either infection of complications of COVID-19 as a result of inhaled COPD medications.
  • It is known that good control prevents COPD exacerbations triggered by other viruses.

It makes sense to maintain current medications and good symptoms control.

Exacerbations

  • There is debate about the use of steroids to treat COVID illness. Some feel steroids may make the illness worse in critically ill patients, while others argue they have a role. This is beyond the scope of primary care. There is no evidence either way for the effect on outcomes for outpatients with milder disease. The CTS therefore take this position:

“We suggest using oral prednisone (or other systemic steroid) for treatment of exacerbations whether or not the exacerbation is caused by SARS-CoV-2”

The document also contains links to online resources for pulmonary rehabilitation

Asthma

Routine Care

  • There is no data indicating increased risk of either infection of complications of COVID-19 as a result of inhaled asthma medications.
  • Recommend continuing preventive medications to achieve excellent control as usual
  • Patients on biologic / immunosuppressant agents – see full document

Exacerbations

  • There is debate about the use of steroids to treat COVID illness. Some feel steroids may make the illness worse in critically ill patients, while others argue they have a role. This is beyond the scope of primary care. There is no evidence either way for the effect on outcomes for outpatients with milder disease. The CTS therefore take this position:

“We suggest using oral prednisone (or other systemic steroid) to treat sever asthma exacerbations as usual (recommended in current national and international guidelines) for treatment of exacerbations, whether or not the exacerbation is caused by SARS-CoV-2”

Physical Distancing

Recommend working from home if possible in mild – moderate asthma

Patients with severe asthma should work form home if feasible and if not feasible should remain off work for medical reasons.

Respiratory Tract Infections

Please see How to Care for Ambulatory Patients with Respiratory Tract Infections: A Toolkit for Using Antibiotics Wisely in the Era of COVID-19 and Virtual Care (Choosing Wisely Canada and CFPC)

Leave a Reply