Covid 19 respiratory

1. COVID 19: RESPIRATORY CONDITIONS
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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.
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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.
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4. ASTHMA
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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.
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6. If oxygen sats are available, a significant change from
baseline is:
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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
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 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
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 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
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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
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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.
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