NICE issue rapid guidelines on the community management of patients with ILD

NICE has issued new rapid guidance on keeping safe those patients in the community with interstitial lung disease (ILD). Many patients with ILD will have received a letter telling them that they are at high risk of severe illness from COVID-19 and advising them to follow guidelines on shielding. There may be others who haven’t but who, as their health professional, you may consider as also being in this group. The British Thoracic Society have issued guidance on identifying patients for shielding from COVID-19.

For all people with ILD, face-to-face contact should be minimised to reduce the risk of infection by.

1. Using telephone, video or email consultations whenever possible
2. Cutting non-essential face-to-face appointments
3. Making multidisciplinary meetings virtual
4. Contacting patients via text message, telephone or email
5. Using electronic prescriptions rather than paper
6. Using different methods to deliver prescriptions and medicines to patients such as pharmacy deliveries, postal services, NHS volunteers

Patients with ILD can have atypical presentations of COVID-19, for example, they may not present with a fever if they are taking corticosteroids. They will also likely be taking antifibrotic and immunosuppressant drugs, the side effects of which can be similar to symptoms of COVID-19 including diarrhoea, fatigue and loss of appetite. Patients should be advised to continue immunosuppressive therapy as prescribed to minimise the risk of their condition worsening. For those requiring prednisolone, the lowest dose possible should be used. Patients should also be assured that there is no evidence that antifibrotic therapy increases their risk of getting COVID-19 or of more severe COVID-19 disease. Home spirometry can be considered if needed for treatment decisions and community blood monitoring services should be preferred over hospital-based services.

Patients should be encouraged to use online help and support services such as those provided by the British Lung Foundation, Action for Pulmonary Fibrosis, the Pulmonary Fibrosis Trust and Sarcoidosis UK. Patients with most severe disease who do not have an individualised advance care plan should be encouraged to develop one.

PCRS have published pragmatic guidance on managing patients presenting with respiratory symptoms in the community.

You can access the PCRS dedicated COVID-19 webpage for the latest information advice and helpful links.