British Thoracic Society: COVID-19 information for the respiratory community

John Minshull, Deputy Director, London Medicines Information Service, Specialist Pharmacy ServicePublished Last updated See all updates

BTS has produced a range of resources covering many COVID-19 related issues. Medicines related guidance is summarised.

Advice and material

The British Thoracic Society COVID-19 information for the respiratory community provides links to guidance, information and resources to support the respiratory community during the COVID-19 pandemic. Some guidance, which may have been more relevant during the peaks of the pandemic, is not being reviewed or updated regularly. However, the latest updates provide guidance or links to further guidance on vaccination, including booster vaccinations. Relevant material includes:

Respiratory care in patients with acute hypoxaemic respiratory failure

Joint BTS and Intensive Care Society guidance on respiratory care in patients with acute hypoxaemic respiratory failure associated with COVID-19 refers to use of Continuous Positive Airway Pressure (CPAP), High-Flow Nasal Oxygen (HFNO) and Non Invasive Ventilation (NIV) therapy. It provides a COVID-19 Respiratory Support Pathway Flowchart to provide guidance for which patients could be looked after in non-critical care settings and what criteria should be used for escalation to areas with higher acuity treatments. The guidance aligns with NICE guidance advising that oxygen prescribing targets on respiratory support units should be adjusted to 92-96%, while the trigger for transfer remains at 94%.

Respiratory follow-up of patients with confirmed COVID-19 pneumonia

BTS Guidance covers respiratory follow-up of patients with radiologically confirmed COVID-19 pneumonia. This guidance focuses on the radiological follow up of the pneumonic process and the subsequent diagnosis and management of respiratory complications of COVID-19 pneumonia. It provides advice on duration of anticoagulation in patients diagnosed with pulmonary embolism during the acute illness.

Oxygen use and safety issues

Oxygen use and safety issues are covered with links to:

Venous Thromboembolic Disease in patients with COVID-19

BTS Guidance on Venous Thromboembolic Disease in patients with COVID-19 is aimed at respiratory and general medical physicians. It summarises published data regarding the risks of VTE in patients with COVID-19 and discusses clinical issues regarding prevention, diagnosis and management of VTE. It includes a table with suggested doses of low molecular weight heparin according to risk/indication.

Inhaler supply

The BTS advice on supply of inhalers appeals to healthcare professionals to help maintain stocks by prescribing only on a monthly basis and advising patients not to stockpile. It discuses whether inhalers are still clinically needed, as well as giving advice on avoiding switching inhaler types if possible (a link to the BTS/SIGN Asthma Guideline inhaler dose comparison chart is provided if alternatives are necessary) and to optimise inhaler technique (with links to online videos/apps).

COPD guidance for healthcare professionals

BTS guidance for healthcare professionals for COPD provides advice on continuing use of inhaled/oral corticosteroids, management of exacerbations with rescue antibiotics and short courses of oral corticosteroids, hygiene of inhalers and spacer devices, and transmission risks with nebulisation.

Asthma guidance for healthcare professionals

BTS advice for healthcare professionals treating adults with asthma includes how to advise patients (e.g. continue regular asthma medications, ensure sufficient supplies without over-ordering, do not share inhalers), management of asthma exacerbations (e.g. use of high dose salbutamol inhalers vs nebulisers, prescribing short courses of oral corticosteroids/antibiotics), and advice for patients with severe asthma including those on biological treatments.

Lung cancer and mesithelioma guidance

BTS lung cancer and mesithelioma guidance includes patient counselling on risks of starting anti-cancer treatments and advice on use of systemic anti-cancer therapy (treatments/monitoring to omit, additional treatments to consider and how to minimise hospital attendance).

Interstitial lung disease (ILD)

BTS guidance for management of people with interstitial lung disease (ILD) includes updated advice on shielding for patients with ILD or sarcoidosis, and provides recommendations for patients already on or newly starting anti-fibrotic medications, e.g. pirfenidone, nintedanib or immunosuppression, as well as general advice on corticosteroids and preparation for post COVID-19 pulmonary fibrosis.

Provision of pleural services

BTS guidance on provision of pleural services during the COVID-19 pandemic includes advice on admission of patients for talc pleurodesis or outpatient Indwelling Pleural Catheter (IPC) insertion, which may be considered if COVID-19 screening is negative  and the procedure/admission can be completed in a non-COVID area with appropriate safety precautions in place.

Pulmonary rehabilitation

BTS guidance on adapted delivery of pulmonary rehabilitation to patients surviving COVID-19 and guidance on reopening pulmonary rehabilitation services to existing patients with chronic lung disease includes Resource packs are provided for resources packs for professionals conducting pulmonary rehabilitation remote assessments and resource packs to support pulmonary rehabilitation whilst face to face PR is not possible

All COVID-19 Specialty Summaries

COVID-19 Specialty Summaries

Clinical specialty guidance for medicines and COVID-19 summarised from a range of professional and government bodies

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