NICE publishes four more rapid guidelines in response to pandemic

The National Institute for Health and Care Excellence (NICE) has published four new rapid guidelines on the active management of patients with suspected and confirmed COVID-19, and in patients without COVID-19.

The guidelines, which are designed to maximise the safety of patients whilst enabling services to make the best use of NHS resources, cover the management of patients with severe asthma, pneumonia, rheumatological autoimmune, inflammatory and metabolic bone disorders and the management of COVID-19 symptoms in the community.

COVID-19 rapid guideline: severe asthma

People should continue to take their treatment as prescribed and only attend essential appointments alone, if possible, to minimise the risk of infection.

Also, patients should be advised to regularly clean equipment such as face masks and mouth pieces, and that they should not share their inhalers and devices with anyone else.

COVID-19 rapid guideline: managing suspected or confirmed pneumonia in adults in the community

As COVID-19 becomes more prevalent in the community, pneumonia is more likely to be caused by the COVID-19 virus than bacteria. Antibiotics should only be offered if: bacteria are the likely cause of infection; it is unclear whether the cause is bacterial or viral; symptoms are more concerning; or the person is at high risk of developing complications.

People should seek medical help without delay if their symptoms don’t improve or worsen rapidly, whether they have been given an antibiotic or not.

COVID-19 rapid guideline: rheumatological autoimmune, inflammatory and metabolic bone disorders:

Patients with COVID-19 should not suddenly stop taking their medication but should seek advice on which medicines to continue and which to temporarily stop.

If they feel unwell, patients should contact their rheumatology team about any rheumatological medicines issues or if their condition worsens contact NHS 111 for advice on COVID-19. Healthcare professionals should use NHS England’s COVID-19 clinical guide when deciding what treatments are appropriate.

COVID-19 rapid guideline: managing symptoms (including at the end of life) in the community

This guideline provides advice to health professionals on the management of cough, fever, breathlessness and anxiety, delirium and agitation in those with COVID-19.

People are advised to first treat a mild cough with simple measures and should also avoid lying on their back as this can make coughing, which helps clear the lungs, more difficult. If the cough is more severe and distressing, codeine linctus, codeine phosphate tablets or morphine sulfate oral solution could be considered for short-term use.

The Institute noted that it would publish further guidelines in due course, which will likely include COPD, cystic fibrosis and dermatological conditions in people receiving immunotherapy.

The guidelines will be made available internationally, so that health systems around the world can see the approach the UK is taking.

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