The National Institute for Health and Clinical Excellence (NICE) guides the UK NHS and its clinicians as well a social care professionals when good, balanced and well-researched opinions are needed for a new situation, or an update is needed for an existing medical condition. Consequently NICE has brought out a series of guidelines for SARS-CoV-2 (COVID-19) coronavirus infections as the epidemic has developed and doctors may refer to those guidelines for the best way to treat their infected patients who also have a respiratory disease.
NICE can also respond to specific questions from clinicians and some questions relate to people with respiratory disease. We know that some steroid medication can leave patients slightly more vulnerable to some types of infection, so the question was posed “is it better to stop taking steroid medication to help prevent a COVID-19 infection or shall we advise patients to continue taking steroid medication to control their symptoms”.
- The first set of guidelines were designed for doctors treating patients with asthma and importantly defines exactly what they mean by severe asthma which is
“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, and/or systemic corticosteroids to prevent it from becoming or remaining ‘uncontrolled’ despite this therapy”
As you might expect much of the document is quite technical, but it is clear that severe asthma patients who get a COVID-19 infection are to continue to use their normal medication including corticosteroid just as they did before infection.
- The second set of relevant guidelines refers to people who have Chronic Obstructive Pulmonary Disease (COPD).
“The new guidance on community-based care of patients with COPD says all patients, including those with suspected or confirmed COVID-19, should continue taking their regular inhaled and oral medicines in line with their individualised self-management plan“.
NICE says there is no evidence that treatment with inhaled corticosteroids for COPD increases the risk associated with COVID-19, so patients established on these drugs should continue to use them, and delay any planned trials of withdrawal. Patients on long-term oral corticosteroids should also be told to continue taking them at the prescribed dose.