New NICE COVID-19 guidelines have been published on severe asthma, pneumonia, rheumatological disorders and symptom management in community settings.
NICE has published the four new rapid guidelines on the active management of patients with suspected and confirmed COVID-19, and in patients without COVID-19. The guidelines have been designed to maximise the safety of patients whilst enabling services to make the best use of NHS resources.
They focus on the management of patients with severe asthma, pneumonia, rheumatological autoimmune, inflammatory and metabolic bone disorders and the management of COVID-19 symptoms in the community.
The guideline on severe asthma says that people should continue to take their treatment as prescribed and only attend essential appointments alone, if possible, to minimise the risk of infection.
The guideline recommends that patients should be advised to regularly clean equipment such as face masks and mouth pieces, and that they should not share their inhalers and devices with anyone else.
As COVID-19 becomes more prevalent in the community, pneumonia is more likely to be caused by the COVID-19 virus than bacteria. Viral pneumonia will not respond to the use of antibiotics therefore they should only be offered if bacteria are the likely cause, it is unclear whether the cause is bacterial or viral and symptoms are more concerning or the person is at high risk of developing complications.
People should seek medical help without delay if their symptoms don’t improve or worsen rapidly, whether they have been given an antibiotic or not.
When possible, clinicians should discuss the risks, benefits and possible likely outcomes of treatment options with patients with COVID-19, and their families and carers, so that they can express their preferences about their treatment.
The guideline on rheumatological autoimmune, inflammatory and metabolic bone disorders says that patients with COVID-19 should not suddenly stop taking their medication but should seek advice on which medicines to continue and which to temporarily stop.
If they feel unwell, patients should contact their rheumatology team about any rheumatological medicines issues or if their condition worsens contact NHS 111 for advice on COVID-19. Healthcare professionals should use NHS England’s COVID-19 clinical guide when deciding what treatments are appropriate.
The guideline on managing symptoms provides advice to health professionals on the management of cough, fever, breathlessness and anxiety, delirium and agitation in those with COVID-19. It includes approaches for managing these symptoms such as considering the use of paracetamol in people with fever.
People are advised to first treat a mild cough with simple measures and should also avoid lying on their back as this can make coughing, which helps clear the lungs, more difficult. If the cough is more severe and distressing, codeine linctus, codeine phosphate tablets or morphine sulfate oral solution could be considered for short-term use.
NICE has already published rapid guidelines covering the management of patients in critical care, the management of patients who are having kidney dialysis and the management of patients who are receiving systemic anticancer treatments.
Further guidelines will be announced in due course but are likely to include: COPD; cystic fibrosis and dermatological conditions in people receiving immunotherapy. NICE will publish new guidelines each based on the priorities for patients and the NHS.
NICE will also make the guidelines internationally available so that health systems around the world can see the approach the UK is taking.
The guidelines are being produced in collaboration with NHS England/Improvement and a cross-specialty clinical group, supported by the specialist societies and Royal Colleges.