Summary of COVID-19 medicines guidance: Respiratory disorders

This page summarises and signposts to medicine related guidance we’re aware of from professional and government bodies relating to coronavirus and respiratory disorders.

This page has been put together rapidly in relation to the COVID-19 pandemic.

Whilst we have tried to ensure that the information on this page is complete, please report a concern if you feel anything is omitted or inaccurate.

To see our professional guidance summaries for other clinical areas, click here

Advice in this area includes:

NHS England/NHS Improvement: Management of respiratory patients

Last updated 26 March 2020

  • This document focuses on the delivery of respiratory medicine during the coronavirus outbreak
  • Includes advice on ambulatory care and management of pleural disease, e.g. use of home IV antibiotic services where possible and provision of clean day case areas for pleural procedures, administration of biologics for asthma, and for line insertions and test doses of antibiotics for CF

NHS England/NHS Improvement: Guidance for the role and use of non-invasive respiratory support in adult patients with coronavirus (confirmed or suspected)

Last updated 6 April 2020

  • Guidance to advise clinicians on the appropriate use of continuous positive airway pressure (CPAP), non-invasive ventilation and high flow nasal oxygen in patients with confirmed or suspected COVID-19.
  • Includes advice to consider drug interactions when instituting low-dose sedation to aid tolerance of CPAP/NIV (e.g. lopinavir-ritonavir with benzodiazepines), and on use of low doses of agents to improve comfort and tolerance.

NHS England/NHS Improvement: Clinical guide for the optimal use of oxygen therapy during the coronavirus pandemic

Last updated 9 April 2020

  • Guidance to assist with managing demand on the flow of oxygen delivery within hospitals by adjustment of oxygen prescribing targets (oxygen saturation).

NHS England/NHS Improvement: Clinical guide for extra corporeal membrane oxygenation (ECMO) for respiratory failure in adults during the coronavirus pandemic

Last updated 10 April 2020

  • Guidance on indications for respiratory ECMO and information and links to forms for referral of patients to the National ECMO service or to seek clinical advice on the management of severe acute respiratory failure

NHS England/NHS Improvement: After-care needs of inpatients recovering from COVID-19

Last updated 5 June 2020

This guidance includes the following therapeutic areas: respiratory, cardiology, neurology, mental health, endocrinology and urology. There is no medication-related information within the neurology, mental health, endocrinology or urology sections.

  • Guidance for management of patients’ physical respiratory needs is given on pages 7-13.
  • Includes recommendations on anticoagulation for patients with pulmonary embolic disease.
  • Reference made to patients requiring cardiac assessment pre-discharge plus plan – with optimisation of medications listed on page 14.

NICE: COVID-19 rapid guideline: severe asthma

Last updated 3 April 2020

  • This guideline includes recommendations for treatment of severe asthma, including biological treatment and corticosteroids
  • It also includes recommendations for safe use of equipment, including face masks, nebulisers, inhalers, spacers and peak flow meters
  • There is a recommendation not to prescribe more than 30 days’ supply of asthma medicines per patient to protect the supply chain

NICE: COVID-19 rapid guideline: community-based care of patients with chronic obstructive pulmonary disease (COPD)

Last updated 9 April 2020

  • This guideline includes recommendations for treatment of COPD including advice on treatment with inhaled or long-term oral corticosteroids, self-management of exacerbations, smoking cessation, pulmonary rehabilitation, oxygen, prophylactic oral antibiotics and airway clearance techniques
  • It also includes recommendations for safe use of equipment, including face masks, nebulisers, inhalers, spacers and peak flow meters, and for patients receiving home non-invasive ventilation
  • There is a recommendation to carry out or defer assessments on a case-by-case basis to establish eligibility for long-term oxygen therapy or home non-invasive ventilation, and not to prescribe more than 30 days’ supply of COPD medicines per patient to protect the supply chain

NICE: COVID-19 rapid guideline: cystic fibrosis

Last updated 9 April 2020

  • Includes advice on safety of nebuliser treatment for patients with known or suspected COVID-19 infection (recommendation 1.14)
  • Provides recommendations on continuing with usual CF self-care treatments of including prophylactic antibiotics (oral and IV), mucoactive agents, CFTR therapies, and diet, vitamins and pancreatic enzyme replacement therapy
  • It also includes recommendations on hygiene of equipment, including face masks and nebulisers, recommendations not to exceed normal quantities of medicines on prescription (usually 30 days) to protect the supply chain, and to follow previous advice on management of exacerbations
  • Advice is given on use of day-case facilities for certain procedures or considering reducing frequency or home visits (recommendation 3.4).
  • Recommendations are provided for access and monitoring of patients on CFTR therapies (recommendation 3.9)

NICE: Medtech innovation briefing myCOPD for self-management of chronic obstructive pulmonary disease

Last updated 1 April 2020

  • Review of the myCOPD digital self-management tool (app), a registered class I medical device, for consideration as part of self-management for people as an alternative to some routine healthcare visits such as pulmonary rehabilitation

NICE: COVID-19 rapid guideline: interstitial lung disease

Last updated 15 May 2020

  • Includes advice for patients to keep a list of their current medicines, conditions and allergies, as well as a copy of a recent clinic letter, to give to healthcare staff if they need treatment for COVID-19.
  • Includes advice on assessing symptoms, including reminders of possible atypical presentation in patients taking immunosuppressants, and potential for confusion with adverse effects of antifibrotics or immunosuppressants and symptoms of COVID-19, as well as increased risk of coagulopathy in patients with ILD and COVID-19 with link to BTS guidelines for VTE (see below).
  • Also recommends considering alternatives to hospital attendance for blood monitoring in patients taking antifibrotics or immunosuppressants, e.g. community blood monitoring services.
  • Provides guidance on starting and continuing treatments (e.g. immunosuppressants and antifibrotics) for ILD, and on oxygen assessment. Also offers guidance on continuing or stopping treatments for ILD in patients known or suspected to have COVID-19, including in patients who develop acute kidney injury or deranged LFTs due to COVID-19.
  • Provides advice on supply of medicines, including planning for managing any disruption to normal supply routes, and advice not to prescribe in large quantities.

Asthma UK: Coronavirus (COVID-19) Health advice for people with asthma

Updated on an ongoing basis

  • Links to guidance for patients on reducing risk of getting coronavirus and managing their asthma well to reduce the risk from coronavirus
  • Shielding advice for very high risk patients and how to identify who should be shielding (e.g. which treatments are included)
  • Guidance for patients with asthma on what to do if they get COVID-19

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

Last updated 21 April 2020

Provides information, guidance and resources to support the respiratory community during the COVID-19 pandemic, as well as further information on identifying patients for shielding and links to resources for patients with lung disease. Of particular relevance to medicines use is:

  • Oxygen use and safety issues, including links to BTS guidance on respiratory support of patients on medical wards, an NHS England/NHS Improvement urgent safety notice for use of high flow oxygen therapy devices during the Coronavirus epidemic,  and a Clinical guide for the management of surge during the coronavirus pandemic: rapid learning, as well as other relevant NHS England/NHS Improvement specialty guides (see links above)
  • BTS guidance on Venous Thromboembolic Disease in patients with COVID-19. This document, aimed at respiratory and general medical physicians, 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.
  • Advice on the safety of nebuliser use.
  • Information related to the suppply of inhalers with an appeal for healthcare professionals to help maintain stocks by prescribing only on a monthly basis and advising patients not to stockpile, and discussing whether inhalers are still clinically needed, as well as advice to avoid 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).
  • Guidance for healthcare professionals for COPD providing 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.
  • Advice for healthcare professionals treating adults with asthma including 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 including 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).
  • 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

Cystic Fibrosis Trust: The impact of coronavirus on your CF care

Last updated 15 April 2020

  • Provides answers to some of the questions raised by people with CF and their families concerned about changes to the way their care is delivered because of the COVID-19 outbreak.
  • Includes a link to for patients to download a CF Medical Information Card to be presented in the event of hospital attendance to inform hospital staff of their treatments or care.

Cystic Fibrosis Trust: Staying home and shielding

Last updated 13 May 2020

  • Provides answers to commonly asked questions about COVID-19 and how it affects people with CF and their families
  • Includes advice about access to medicines and whether to stockpile, as well as advice for people taking part in a clinical trial

Primary Care Respiratory Society: Pragmatic guidance for crisis management of asthma and COPD during the UK COVID-19 epidemic

Last updated 7 May 2020

  • Guide that aims to respond to questions from primary care, especially around steroid use.
  • Questions about medicines include whether oral corticosteroids (OCS) worsen outcomes, whether rescue packs should be issued, whether nebulisers should still be given if indicated, whether all asthma patients should be started on inhaled corticosteroid (ICS), whether ICS should be stopped or reduced in stable asthma or COPD, and whether to advise patients to increase ICS dose or use OCS in asthma attacks or COPD exacerbation if Covid-19 may be the cause.