Covid-19 Respiratory - Comment
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1. COVID 19: RESPIRATORY CONDITIONS www.belmatt.co.uk. Prepared by Aneela Tehseen and Jeshni Amblum-Almér 2. Asthma • Asthmatics with mild–moderate disease usually have normal lungs when well controlled. • Maintenance therapy will not require changing when they are well as as inhaled corticosteroids from used in asthma therapy have not been shown to be immunosuppressant and should be continued. • BTS guidelines on provision of a rescue pack for patients with a good understanding of their personalised asthma action plan may be sensible in the current health climate. Issue a peak flow meter so they can monitor at home. Rescue packs should be issued as acute and SHOULD NOT be on repeat as each exacerbation requires a review. • Acute exacerbations of asthma should be treated in the normal way, including oral steroids. www.belmatt.co.uk. Prepared by Aneela Tehseen and Jeshni Amblum-Almér 3. Acute asthma vs. COVID-19 • Differentiating an acute exacerbation of asthma from COVID-19 may be difficult. Pragmatically, fever and change of taste/smell are unusual in asthma. Decide (as best you can) which is more likely. If COVID-19 suspected, remember: • Oral steroids are NOT a treatment for COVID-19. In practice, this means that if an asthmatic has mild COVID symptoms but with no significant asthma symptoms, we should not give prophylactic oral steroids. • However, if typical asthma exacerbation features are dominant (wheeze/bronchospasm), oral steroids should be used as per asthma guidelines. Use shortest duration. • Twice as much steroids when ill under the guidance of medical practitioner. www.belmatt.co.uk. Prepared by Aneela Tehseen and Jeshni Amblum-Almér 4. ASTHMA www.belmatt.co.uk. Prepared by Aneela Tehseen and Jeshni Amblum-Almér Concern Management Wheeze/Bronchospasm But NO fever Treat as an exacerbation. Possible COVID-19 ie SOB/Cough/fever - Fever: Paracetamol & oral fluids - Possible Secondary Bacterial Pneumonia: As per severity of symptoms choose: Moderate: Amoxicillin 500mg TDS+ Clarithromycin 500mg BD for 7 days OR Doxycycline 200mg stat and then 100mg OD for 6 days Moderately severe: Co-Amoxiclav 625mg TDS + Clarithromycin 500mg BD for 7 days OR Azithromycin 500mg OD for 5/7 Days (If no other option). - Wheezing/SOB: High dose of SABA (4-8 puffs via large volume spacer). Do not introduce nebules, only to be used if patient previously using nebules. 5. COPD • There is NO evidence for ‘just in case antibiotics’ OR using prophylactic antibiotics. • Treat apparent exacerbations as you normally would, irrespective of possible organism, which means: • Use antibiotics if suspected bacterial infective exacerbations (more sputum/change in sputum colour). • Consider oral steroids for increased breathlessness: but first check that symptoms can’t be managed with increasing bronchodilators, breathing exercises, pacing. Have a lower threshold to use steroids in those with asthma–COPD overlap or previous raised eosinophils as they are likely to get greater benefits. Do not use if patient has a fever. If using, offer 30mg prednisolone for 5 days. • Remember, anxiety can also drive breathlessness/tachycardia: a phone/video consultation can help reassure people. www.belmatt.co.uk. Prepared by Aneela Tehseen and Jeshni Amblum-Almér 6. If oxygen sats are available, a significant change from baseline is: www.belmatt.co.uk. Prepared by Aneela Tehseen and Jeshni Amblum-Almér Mild: < 2% below baseline Moderate: 3– 4% below baseline sats Severe: ≥5% below baseline sats 7. www.belmatt.co.uk. Prepared by Aneela Tehseen and Jeshni Amblum-Almér COPD Worsening SOB But No Fever - Use high dose SABA (4-8 puffs via large volume spacer). Do not introduce nebules, however, if patient has already got nebules may step up the dose. - Oral steroids only to be considered if 1. Mixed COPD+ Asthma 2. COPD with h/o high Eosinophil ≥0.3 COPD Increase sputum amount/ Sputum discolouration BUT No chest pain No fever No loss of Activity of Daily Living (ADL) Treat as infective COPD Exacerbation Reminder (No oral steroids to be used) 8. COPD : POSSIBLE COVID 19 Possible COVID-19 with SOB/New continuous cough/ fever/ Chest tightness or pain/ Decline in ADL/Lethargy www.belmatt.co.uk. Prepared by Aneela Tehseen and Jeshni Amblum-Almér - Fever: Paracetamol and oral fluids. - Secondary bacterial Pneumonia As per severity of symptoms choose: Moderate: Amoxicillin 500mg TDS+ Clarithromycin 500mg BD for 7 days OR Doxycycline 200mg stat and then 100mg OD for 6 days AND: Treat SOB using SABA high dose via large volume spacer. Patient may use nebules if has got them at home. Moderately severe: Co-Amoxiclav 625mg TDS + Clarithromycin 500mg BD for 7 days OR Azithromycin 500mg OD for 5/7 Days (If no other option). Please note this group may be appropriate for COVID-HOT hub assessment and management AND - Treat SOB using SABA high dose via large volume spacer. Patient may use nebules if has got them at home. 9. Interstitial Lung Disease www.belmatt.co.uk. Prepared by Aneela Tehseen and Jeshni Amblum-Almér - Currently under Shielding (12 weeks) - Will not do well with intubation/ mechanical ventilation - Likely to become hypoxic very quickly - Mostly have advanced care plan in place If has developed symptoms of possible COVID-19 → - Admission will be guided by deterioration of SpO2 from baseline (up to 2% decline is mild, 2-4% is moderate and ≥5% decline from baseline is severe deterioration) - Consult Advanced care plan for management decisions - Antifibrotic Biologics can be paused for up to 8 weeks - Do not stop Long term Oral Steroids - DMARDs to be paused and re-initiated 2 weeks after recovery. - Elongate the shielding time (Beyond 12 weeks) 10. Obstructive Sleep Apnea www.belmatt.co.uk. Prepared by Aneela Tehseen and Jeshni Amblum-Almér Have normal Lung function Should they develop COVID-19 symptoms (A new continuous cough/fever/chest tightness/SOB/lethargy/decline in ADL) follow the decision tree as for all members of public Should these patient need hospitalisation, advise to take CPAP machine with them to use at hospital 11. Bronchietasis Development of discoloured purulent sputum But No chest pain No fever No loss of Activity of Daily Living (ADL) Treat as an exacerbation with standard dose Amoxicillin or Doxycycline for 10-14 days Do not collect sputum samples If non-respondent to the above may consider Ciprofloxacin but seek specialist advice. 12. Bronchietasis: Possible COVID 19 www.belmatt.co.uk. Prepared by Aneela Tehseen and Jeshni Amblum-Almér Possible COVID-19 i.e. • SOB/New continuous cough/ fever • Chest tightness or pain • Decline in ADL • Lethargy With/without purulent sputum Fever: Paracetamol and oral fluids + As per severity of symptoms choose: Moderate: Amoxicillin 500mg TDS+ Clarithromycin 500mg BD for 7 days OR Doxycycline 200mg stat and then 100mg OD for 6 days AND: Treat SOB using SABA high dose via large volume spacer. Patient may use nebules if has got them at home. Moderately severe: Co-Amoxiclav 625mg TDS + Clarithromycin 500mg BD for 7 days OR Azithromycin 500mg OD for 5/7 Days (If no other option). Please note this group may be appropriate for COVID-HOT hub assessment and management 13. References • References: • http://primarycarepathways.co.uk/covid-19/clinical- assessment/pathways/177-barnet-primary-care-pathway-during-covid19- v2-0-pdf/file • Accessed 03/04/2020 • http://primarycarepathways.co.uk/covid-19/clinical-assessment/241- primary-care-and-community-respiratory-resource-pack-during-covid-19- nhs-london-clinical-networks/file • Accessed 03/04/2020 • The above guidance is correct and up to date as of 03/04/2020. It is subject to amendment as the pandemic progresses. www.belmatt.co.uk. Prepared by Aneela Tehseen and Jeshni Amblum-Almér |
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| Posted by : peter88 | Post date : 2020-10-19 15:52 | ||
| Category : Health & Medicine | Views : 318 | ||
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