COVID-19: Severe asthma

Patients with severe asthma – defined as asthma that requires treatment with high-dose inhaled corticosteroids plus a second controller or oral corticosteroids to prevent it becoming uncontrolled – are at greater risk than the general population from COVID-19 infection, so it is more important than ever that their treatment is uninterrupted. This Guideline in a Nutshell summarises the latest rapid guidance from NICE.

Severe asthma is defined by the European Respiratory Society and American Thoracic Society as asthma that requires treatment with high-dose inhaled corticosteroids plus a second controller or oral corticosteroids to prevent it becoming uncontrolled, or which remains uncontrolled despite therapy.

Patients with severe asthma are among the groups who have been advised to follow the Government advice on shielding because they are extremely vulnerable to COVID-19.

These patients, including those with the virus or suspected of having it, should be advised to continue to take their regular medicines in line with their personalised asthma action plan (PAAP), which should be up-to-date). It is important to make sure their asthma is as stable as possible.

Minimise face-to-face contact

Face-to-face contact should be minimised, by:

• Offering telephone, video or email consultations whenever possible. See Changing the way we work: virtual consultations now and in the future
• Cutting non-essential face-to-face appointments
• Contacting patients by text message or email
• Using alternative ways to deliver prescriptions such as postal services, NHS volunteers or drive through pick up points.

Face-to-face appointments

If patients are attending for a face-to-face appointment, they should first be screened by phone on the day to make sure they haven’t developed symptoms.

To reduce the risk of contracting or spreading the infection, ask patients to attend alone if possible, or with only one family member or carer. A child should be accompanied with only one adult.

Minimise time in waiting areas by:

• Careful scheduling
• Encouraging patients not to arrive early
• Texting patients when you are ready to see them so they can wait in their car, for example.

Investigations

Only carry out investigations including spirometry for urgent cases and if the results will have a direct impact on patient care, because tests have the potential to spread COVID-19. See Association for Respiratory Technology and Physiology advice.

Treatment

Advise patients to continue using ICS because stopping can increase the risk of asthma exacerbation. There is no evidence that ICS increase the risk of COVID-19 infection.

Patients on maintenance oral corticosteroids (OCS) should continue to take them at their prescribed dose because stopping them can be harmful.

Patients who develop symptoms and signs of an exacerbation should follow their PAAP and start a course of OCS if clinically indicated.

Patients having biologic treatments should continue to do so. If possible, they should be trained to self-administer or be treated in the community or at home rather than attending hospital. Patients starting biologic treatments should not have their treatment postponed.

Equipment

Patients should wash their hands and clean equipment such as face masks, mouth pieces, spaces and peak flow meters regularly using washing up liquid or follow the manufacturer’s instructions. Patients should be told not to share inhalers with anyone else.

Prescribing

Prescribe enough medication to meet patients’ clinical need for no more than 30 days’ treatment. Prescribing larger quantities puts the supply chain at risk.

Reference

NICE NG166. COVID-19 rapid guideline: severe asthma; 3 April 2020

https://www.nice.org.uk/guidance/ng166