Patients with COPD may have had less contact with healthcare professionals due to COVID-19 and lockdown restrictions and may be struggling to manage their condition alone. The purpose of this article is to suggest ways of managing patients with COPD in light of the added challenges that the COVID-19 pandemic poses to effective disease management.

Keeping track

COPD patients are more likely to suffer severely if infected with COVID-19 due to already established lung damage and an impaired immune system due to inflammation.1 And with more patients seeking advice and support due to concerns about the impact of COVID-19 on themselves and their condition, monitoring and assessing patients with COPD carries increased importance during the pandemic.1

Some patients with COPD may be avoiding attending hospital for an emergency whilst struggling with an exacerbation during lockdown, therefore it’s important to inform your patients that they should still visit the hospital if they do need emergency care.2 Hospital appointments should be restricted to essential diagnostic tests and lung function assessments for procedures or surgery during times of high prevalence of COVID-19, but check with your individual country’s guidance for more local advice.3

It’s more important than ever to make sure that your patients’ symptoms are being monitored during the pandemic and that their disease is being managed sufficiently. Be alert to any changes or worsening of symptoms and inform patients of the importance of communicating any changes they may notice to their HCP.3

It may also be beneficial to assess your patient’s technique when using their inhalers, either remotely or in person, to ensure that their self-medication routine is efficient.2 As patients may be more isolated than usual, check that they have been collecting their prescriptions or have been receiving deliveries.

Patients with COPD may have reduced the amount of physical activity they normally carry out due to lockdown.2 Ask your patient if they have been keeping up with any physical activity or their pulmonary exercise programme and give appropriate advice on keeping active.3 You can access more advice and guidance for patients on pulmonary rehabilitation exercises here.

Diagnosing patients with COPD during COVID-19

An added problem during these times may lie with patients who are yet to receive a diagnosis for their condition, and therefore receive effective treatment. Patients looking for an answer to their problems may be facing more fear than they might have done pre-COVID-19. Late diagnosis of COPD can be a barrier to the planning of a patients care and can have a significant impact on exacerbation rate, increased comorbidities and an increased cost to healthcare services.4,5 It is important that patients can still access diagnostic tools and appropriate healthcare.

Diagnosing COPD has become a difficulty during the COVID-19 pandemic due to reductions in face-to-face appointments and access to spirometry testing.3 In circumstances where a spirometry test is not possible, peak expiratory flow and patient questionnaires or personal electronic spirometers can be used as an alternative in the diagnostic process.3

Providing reassurance

As well as physical health, the pandemic has impacted many people’s mental health. Some of your patients may need additional support and guidance with how to manage their mental health, especially if dealing with their illness alone. Encouragement and reassurance can help your patients in managing their situation.

  • Reassure patients of the safety measurements that have been put in place at their clinics and hospitals. They may fear contracting Covid-19 as high-risk patients.4
  • Encourage patients to arrange appointments if they experience an exacerbation or experience any changes in symptoms.
  • Action and self-management plans are in important factor in controlling COPD symptoms. An action plan aims at recognising symptoms early so that patients can self-manage and initiate interventions.6 Self-management plans carry the potential to reduce exacerbations and increase quality of life.7
  • Your patients may benefit from more support with disease management whilst they may be spending more time at home. Internet-based or smart-phone applications can be a useful tool in supporting home rehabilitation, particularly during the pandemic.3
  • Continue to encourage patients to make healthy lifestyle changes such as quitting smoking, keeping active and eating balanced meals, as these factors can aid in boosting the immune system.
  • Encourage patients to communicate with loved ones via phone, video or instant messaging, especially if they are isolated.
  • Depression and anxiety disorders are common amongst patients with COPD.2 Furthermore, patients with COPD have reported an increase in their anxiety about their disease during lockdown.2 It is important to reassure patients that their healthcare professionals are there to help them and that support is available for worsening or new problems with mental health.

Covid-19 and COPD Exacerbations

Several symptoms associated with COPD are also present in COVID-19 patients, making differentiating between early signs of COVID-19 and COPD exacerbations difficult.3 In addition to this, an exacerbation could be caused by infection with COVID-19, as viral infections are a major cause of exacerbations in COPD.1 Remain vigilant when patients present with symptoms of an exacerbation, particularly if symptoms include fever, gastrointestinal complaints, headache, a new or worsening cough or impaired/loss of taste or smell.3 As most patients likely have a chronic cough due to their COPD, it is worth keeping in mind that a cough caused by COVID-19 is accompanied by one or more of the aforementioned symptoms in >60% of COPD patients.3

Coinfection may occur in COPD patients who test positive for Covid-19: 20-30% of patients hospitalised due to exacerbation present with viral and bacterial coinfection, increasing the severity of exacerbation.1 Because of this it’s important to assess the patient for coinfection and treat with the appropriate antibiotics.3 If you or your patients are concerned about their symptoms, arrange for a COVID-19 test.

Video Consultations

Where face-to-face appointments are not possible, or are deemed too great a risk, video consultations may be an appropriate alternative.8 It is important to bear in mind that many patients with COPD are elderly therefore, phone consultations are essential here where face-to-face appointments aren’t possible.

  • Additionally, remember to consider patients with hearing loss or disabilities that could impact their ability to attend virtual appointments.

For guidance on conducting effective remote consultations, see our checklist here.

Useful resources