'What is High dose/High Risk Asthma' in Covid isolation 12 weeks
within GP land we are having so many patients ringing up asking if they can have a letter for work stating they are high risk and need to be off for 12 weeks. They have looked on asthma.org - on fostair and montelukast .
Any thoughts how to deal with this, decide who is 'high dose steriods - is it 800-1000 day - mart?
feels like its opening a can of worms and having to distinguish is difficult with mart.
We are also having the same problem. Looks like this is the latest advice out https://digital.nhs.uk/coronavirus/shielded-patient-list People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD. Severe asthmatics are those who are frequently prescribed high dose steroid tablets. In Leeds we have 25% of patients with asthma on high dose ICS/LABA........
This was an email from NHSE: Earlier this week we wrote to you regarding the process for identifying and supporting patients at highest clinical risk from coronavirus.
• In line with the letters from Chief Medical Officer (CMO) and NHS England and NHS Improvement, all patients included in the CMO defined cohort that could be identified through centrally available data should have been flagged in practice IT systems.
• We knew the data in the initial extract would not be complete due to the limitations of centrally available data. Next week, NHS Digital will update the original cohort and identify some additional patients based on GP data. Any additional patients identified will be flagged in GP systems in the same way as the original cohort and practices will have an updated report in their system.
After this next update, we would like practices to review the list for accuracy and identify any additional patients who meet the CMO’s original criteria but are not included amongst those identified. We will provide further details of how this should be done via GP system suppliers.
• there may be other patients, not included in the original CMO cohort, that GPs consider to be in the highest risk category and who should be advised to shield.
• Please do not run searches to identify these cohorts at this stage. NHS Digital and ourselves will be in touch next week to confirm how this process can be streamlined for GPs.
• In the meantime, please start to consider specific patients within your practice who may fall into this category of extremely vulnerable on medical grounds. We expect this to be small numbers; shielding will only be effective if we focus these most stringent protective measures on those at the highest clinical risk.
We have written to those who have been admitted in the last year, or who have been ventilated ever (the last being impossible to identify and thus ridiculous) which is in line with BMA advice. (Group C I think this is known as). And in contrast to what has been published in AsthmaUKs website, which is far more sensible.
But asthma is not like COPD; you can't define severity according to lung function or the amount of drug prescribed.
The problem is that "asthma severity" is not only variable and poorly defined, but often classified by the amount of drug taken, rather than more correctly by the degree of symptom control.
Remember the GOAL study? "The aim of asthma management is control of the disease". Its in every guideline.
Thus you can have people on very high doses of therapy who are well controlled, and people on very low doses of therapy who are very poorly controlled. If this were all done correctly, then we would be assessing severity by ACT scores.
I really don't know what the answer is to this impossible situation. Use your gut feeling and common sense, perhaps?
The data from around the world shows that asthma patients are NOT developing the severe lung complications of COVID-19 as was originally feared. In fact inhaled steroids might confer a protective benefit against the lung damage and ARDS. So although PHE had severe asthmatics on the 12 week self isolation category we can give some reassurance to patients from what we know today.
The Lancet article by David Haplin states: "One might anticipate that patients with chronic respiratory diseases, particularly chronic obstructive pulmonary disease (COPD) and asthma, would be at increased risk of SARS-CoV-2 infection and more severe presentations of COVID-19. However, it is striking that both diseases appear to be under-represented in the comorbidities reported for patients with COVID-19, compared with the global burden of disease estimates of the prevalence of these conditions in the general population (table); a similar pattern was seen with SARS. By contrast, the prevalence of diabetes in patients with COVID-19 or SARS is as high as or higher than the estimated national prevalence, as might be expected." Do chronic respiratory diseases or their treatment affect the risk of SARS-CoV-2 infection? APRIL 3rd 2020