COVID-19 – BTS Guidance Collection – Asthma Exacerbations

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The British Thoracic Society have published COVID-19: information for the respiratory community – a collection of guidelines & information sheets for HCPs managing respiratory conditions during the COVID-19 pandemic.

The collection includes Advice for Healthcare Professionals Treating People with Asthma (adults)
in relation to COVID‐19 – with the following information & advice about Acute Exacerbations:

COVID‐19 can present with symptoms similar to an asthma attack such as cough and shortness of breath. However, it is worth letting patients know that it is uncommon to get a high temperature and changes in taste or smell with an asthma attack so the presence of these symptoms are more likely to suggest infection with SARS‐CoV‐2. If patients are not unwell enough to need hospital treatment, they should be advised to self‐isolate at home (‐covid‐19/self‐isolation‐advice/) and follow their asthma action plan.

The management of asthma exacerbations is unchanged and patients should NOT stop taking their ICS containing inhaler. Patients should be advised to take their medication as guided by their personal asthma action plan and contact their GP surgery to organise a telephone, video or face‐to‐face consultation. If a course of steroids is clinically indicated (symptoms and signs of bronchospasm/wheeze), it should not be withheld. Antibiotics are only advised if sputum changes colour, thickens or increases in volume. As health services are likely to be stretched for the next few months, if patients have a good understanding of their self‐management plan then it is reasonable for them to have a short course of steroids at home (rescue pack). This is particularly important for patients with severe asthma. Refer to BTS/SIGN Guideline for the management of asthma.

Oral steroids are not currently prescribed as part of the treatment for COVID‐19. If your patient develops symptoms and signs of an asthma exacerbation then they should follow their personalised asthma action plan and start a course of steroids if clinically indicated.
For patients on maintenance oral corticosteroids:

  • They should continue to take them at their prescribed dose as stopping steroids suddenly can be harmful.
  • It is worth reiterating the “sick day rules” and reminding patients that if they become unwell (for any other reason) they need to increase their steroid dose appropriately (usually doubled).