COVID-19: how to protect people with chronic obstructive pulmonary disease
Those with COPD should self-isolate to avoid coronavirus infection, but respiratory nurses can provide care remotely
As a respiratory nurse consultant, I found it interesting how quiet services such as our community chest team, chest clinic, emergency department (ED) and respiratory wards were in the early days of the COVID-19 outbreak.
I think people we would normally see at home or who would go to the ED were terrified of contracting COVID-19.
Social distancing and self-isolation for people with COPD
Patients with chronic obstructive pulmonary disease (COPD) are at particularly high risk of severe illness if they become infected with COVID-19 and may develop pneumonia, so prevention is crucial.
To keep well, people with COPD should follow the standard advice given to the general public on reducing the risk of infection, including handwashing often and for 20 seconds, using a tissue for coughs and sneezes, avoiding touching the eyes, nose and mouth, staying home, disinfecting surfaces, and avoiding non-essential contact with others.
Social distancing is, of course, important for everyone but people with severe COPD have been advised to self-isolate and stay at home for 12 weeks.
Similarity of symptoms for COPD and COVID-19
For respiratory care professionals, one problem is that the symptoms of COPD and COVID-19 are similar. The main symptoms of COVID-19 are cough, fever, fatigue and shortness of breath, while people with COPD who experience exacerbations of their symptoms may also have shortness of breath and a cough, with or without sputum.
Typically, exacerbations of COPD are not associated with high fever, but it can be difficult to work out whether symptoms are due to COVID-19 or a flare-up of a patient’s condition.
To reduce the risk of infection, healthcare consultations can be conducted via the telephone or technology such as Skype, rather than face-to-face. Lung function testing should only be performed in urgent cases.
The advice I would give nursing staff answering a call from someone with COPD is to ask more questions about shortness of breath, cough, the nature of the cough and if it has changed in any way, and fever. A thorough assessment will be necessary to identify the risk of COVID-19 infection and guidance is available on remote assessment.
If you are undertaking face-to-face consultations, make sure you have the appropriate personal protective equipment (PPE).
Advice for people with COPD on self-management at home
The National Institute for Health and Care Excellence recommends people with COPD have a plan to help them self-manage their illness. A key factor is for patients to consider stopping smoking. Smokers are likely to be more vulnerable to COVID-19, so providing advice and support to help patients stop is essential. It is also important for patients to ensure they have enough supply of their medication and take it correctly.
‘Being vulnerable may make someone more anxious and feeling anxious exacerbates breathlessness. A vicious cycle can develop, so ensure patients understand how to manage their COPD, breathlessness and the psychological impact of their illness'
Exacerbations of COPD may require a course of antibiotics or steroids. Some patients will have rescue packs; they should know when to start these and should inform their GP practice if they do.
Those with mild symptoms of COVID-19 who are at home can be supported by respiratory services such as community chest teams. The British Thoracic Society offers information, guidance and resources. Patients should be advised to contact NHS 111 and should remain at home unless symptoms do not improve after seven days, or their condition gets worse.
Being active is important for physical and psychological well-being. Self-isolation makes this harder but it is very important to encourage patients to keep active at home. The British Lung Foundation has some brilliant exercise videos for patients.
Mental health challenges of self-isolation
One of the challenges ahead will be ensuring that people continue to realise the importance of social distancing and self-isolation. If we become complacent, the virus will rear its ugly head again.
But that’s also a challenge from a mental health point of view. Symptoms of anxiety and depression are common in COPD and may be made worse because of patients’ fear of the risk and impact of COVID-19 and the impact of having to stay at home.
Being vulnerable may make someone more anxious and feeling anxious exacerbates breathlessness. A vicious cycle can develop, so ensure patients understand how to manage their COPD, breathlessness and the psychological impact of their illness.
Exploring patients’ concerns is extremely important and supporting them to identify ways of coping with their feelings can help. Breathing techniques, such as slow, long breaths out and distraction can ease breathlessness and feelings of anxiety.
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Keeping in touch with our patients is crucial at times like this
Encouraging patients to stick to a routine, perhaps writing ‘to do lists’ to keep occupied and taking up or maintaining hobbies can also help, while staying connected with friends and family, via phone or technology, is really important.
Loneliness, which can increase the risk of premature death by 30%, is a big problem and will be made worse by the COVID-19 pandemic, so it is crucial people maintain links.
Keeping in touch with our patients can really be comforting for them at this difficult time, although I think the virus will change ways of working permanently. We’re doing far fewer face-to-face consultations now, except for first appointments and for important procedures.
It is also important for staff to stay in touch with each other and support one another. We’ve set up a WhatsApp group for our chest clinic team. One positive is that people are working together brilliantly; there are no barriers where there may have been before. Now, things that once might have taken months are being moved on by everyone.
Karen Heslop-Marshall is a nurse consultant, Royal Victoria infirmary, Newcastle upon Tyne
The British Lung Foundation has a dedicated helpline for people with respiratory problems – call 03000 030 555
- COVID-19: information for the respiratory community (British Thoracic Society)
- British Lung Foundation exercise videos
- COVID-19: a remote assessment in primary care (BMJ)
- COVID-19: Goverment guidance on shielding including people with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD