Chronic Obstructive Pulmonary Disease (COPD) in the COVID-19 Context
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
COPD patients do not appear to be more likely to acquire COVID-19, but they do appear to be at a significantly greater risk for developing severe COVID-19, if infected (CTS, April 8, 2020; Int J Public Health, May 25, 2020; PLoS One, May 11, 2020).
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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, November 30, 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
- For advice on how to conduct virtual visits with COPD patients, consult The virtual COPD visit in the COVID-19 pandemic (CFP, May 6, 2020).
- Consider sending the COPD Assessment Test (CAT) to patients in advance of your virtual visit, to help both of you to better understand the severity of their COPD, while helping to inform management decisions
- Consider enrolling patients in Telehomecare for COPD (Ontario Telemedicine Network), a free six-month program that links COPD patients with Registered Nurses providing remote monitoring and intensive health coaching.
Treatment
It is important for patients with COPD to adhere to COPD treatment during the COVID-19 pandemic (CTS, April 8, 2020; The Lung Association, June 2, 2020).
Putting it into practice
The Canadian Thoracic Society recommends (CTS, April 8, 2020):
- 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)
Resources
For patients
Supports
- Lung Health Line (Lung Health Foundation): 1-888-344-5864
Oxygen and respiratory services
- North: North West, North East
- West: Erie St. Clair, South West, Waterloo Wellington, Hamilton Niagara Haldimand Brant
- Central: Central West, Central, Mississauga Halton, North Simcoe Muskoka
- East: Central East, South East, Champlain
- Toronto: Toronto Central
Resources
For providers
- The virtual COPD visit in the COVID-19 pandemic (CFP, May 6, 2020)
- Addressing Therapeutic Questions to Help Canadian Health Care Professionals Optimize COPD Management for Their Patients During the COVID-19 Pandemic (CTS, April 8, 2020)
In the event of medication shortages, consult:
- Table of comparative medication doses for how to manage medication shortages (RxFiles).
- CTS’s mitigation strategies for communication tips and suggestions for salbutamol substitutions.
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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Acknowledgement and legal
The COVID-19 Resource Centre was developed by the Centre for Effective Practice (CEP) in collaboration with the Department of Family Medicine at McMaster University, the Ontario College of Family Physicians and the Nurse Practitioners’ Association of Ontario using a rapidly modified version of the CEP’s integrated knowledge translation approach.
They are some of several clinical resources developed as part of the Knowledge Translation in Primary Care Initiative. Funded by the Ministry of Health and Long-Term Care, this initiative supports primary care providers with the development of a series of clinical tools and health information resources. Learn more about the Knowledge Translation in Primary Care Initiative.
Clinical Working Group
A clinical working group was established and provides significant input and oversight into the development of this resource. Members include:
• Claudia Mariano, MSc, NP-PHC
• Darren Larsen, MD, CCFP, MPLc
• Derelie Mangin, MBChB (Otago), DPH (Otago), FRNZCGP (NZ)
• Dominik Nowak, MD MHSc, CCFP, CH
• Jennifer P. Young, MD, FCFP-EM
• Lee Donohue MD, CCFP, MHSc, MPLc
• Mira Backo-Shannon, MD, BSc, MHSc
• Paul Preston, MD, CCFP, CCPE, CHE
• Rob Annis, MD, CCFP
• Soreya Dhanji, MD, CCFP
In addition to our clinical working group the CEP also obtained feedback from others, including:
• Arun Radhakrishnan, MSC, MD, CM, CCFP
• David Price, BSC, MD, CCFP, FCFP
• Jose Silveira, BSC, MD, FRCPC, DIP, ABAM
• Michael Chang MD, FRCP(C)
• Payal Agarwal, MD, CCFP
• Robert Sauls MD, CCFP(PC), FCFP
• Tara Walton, MPH
Thank you to everyone who supported the development of this resource.
Conflict of interest
• Clinical Leads receive compensation for their role
• Clinical Working Group receive an honorarium for their participation
• Focus group and usability participants receive a small token of appreciation (e.g. gift certificate)
The Chronic Obstructive Pulmonary Disease (COPD) in the COVID-19 Context resource is a product of the Centre for Effective Practice. Permission to use, copy, and distribute this material for all non-commercial and research purposes is granted, provided the above disclaimer, this paragraph and the following paragraphs, and appropriate citations appear in all copies, modifications, and distributions. Use of the Chronic Obstructive Pulmonary Disease (COPD) in the COVID-19 Context resource for commercial purposes or any modifications of the Tool are subject to charge and use must be negotiated with the Centre for Effective Practice (Email: info@cep.health).
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