Chronic Obstructive Pulmonary Disease (COPD) in the COVID-19 Context

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The Chronic Obstructive Pulmonary Disease (COPD) in the COVID-19 Context tool is revised often and new content is added regularly to guarantee that the latest evidence and regulatory recommendations are included. The CEP is committed to ensuring this information is accurate and up to date.
Last reviewed: November 26, 2020
Last updated: October 21, 2020

Now more than ever it is important for your patients to look after their health and receive care from you as their healthcare provider. It’s essential that patients continue to seek out care that they need.

This tool has been developed to support primary care providers in navigating and providing patient care in a world where COVID-19 is the ‘new normal’, with considerations and recommendations on what’s ‘new’ and what’s ‘changed’ in the delivery of care for patients living with Chronic Obstructive Pulmonary Disease (COPD).  While how care is delivered has changed, efforts should be made to ensure that the quality has not. As always, when treating your patients, continue to use your clinical judgement and follow standards of care, best practices, evidence and guidelines.

Seek support:  If you need support providing the best care possible for your patients, you can consult specialists via OTN eConsult.

Key takeaway

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Management

Leverage remote/virtual care approaches when conducting regular assessments.

Discuss wearing a mask and address any concerns or anxieties the patient might have.

  • There is no evidence that wearing a facemask will exacerbate an underlying lung condition (CTS, June 2, 2020). If breathing through a mask causes a patient to feel short of breath, they should remove the mask, and if symptoms do not immediately settle, they should follow their existing strategy for relief of acute symptoms.
  • If wearing a facemask is not possible despite best efforts, patients should instead avoid or minimize circumstances where physical distancing is not possible.

Connect patients with remote monitoring and management supports.

Putting it into practice

Treatment

Putting it into practice

  • Inhaled maintenance therapies: Continued use of inhaled maintenance therapies for COPD. These medications help to minimize risk of a COPD exacerbation and optimize lung function (UpToDate).
  • Corticosteroids: Cautious use of oral prednisone or other systemic corticosteroids (if clinically warranted) to treat acute exacerbations of COPD. The usual guidelines for prompt initiation of systemic glucocorticoids for a COPD exacerbation should be followed, as delaying therapy can increase the risk of a life-threatening exacerbation (UpToDate). Dosage should be low-to-moderate (≤ 0.5-1 mg/kg per day methylprednisolone or equivalent) and duration should be short (≤ 7 days) for exacerbations suspected to be caused by COVID-19 infection (CTS, April 8, 2020).
  • Oxygen therapy: Continued use of oxygen as prescribed. Patients should clean their equipment, including hosing, routinely, following the manufacturer’s instructions for cleaning and maintenance. Patients should call 911 if they experience extreme distress (CTS, April 8, 2020).
  • Nebulized therapy: Nebulized therapy should be avoided during this pandemic. Patients who are already using nebulizers at home should continue to do so until they discuss switching to an alternative with their family physician/primary care nurse practitioner. Alternatives to nebulized therapy include therapy with a metered dose inhaler (MDI) with spacing device, a dry powder inhaler or a soft mist inhaler (CTS, April 8, 2020).

Approximate equivalent of nebule vs puffers (MDI) (CTS, April 8, 2020):

Salbutamol

1 nebule (2.5mg / neb)

4 puffs (100mcg / puff)

Ipratropium

1 nebule (500mcg / neb)

4-8 puffs (20mcg / puff)

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These supporting materials and resources are hosted by external organizations. The accuracy and accessibility of their links are not guaranteed. CEP will make every effort to keep these links up to date.

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