By Gerene Bauldoff, PhD, RN, MAACVPR
As we continue in the COVID-19 era, this column provides an antecedent to the November 2020 News and Views pulmonary column on PR and COVID-19. This scientific report by the Global Obstructive Lung Disease (GOLD) initiative provides early evidence-based answers regarding COPD management in the face of COVID-19. This report is available open access and was published January 1, 2021, in the American Journal of Respiratory and Critical Care Medicine.
The authors describe the emerging evidence related to COPD management in the COVID-19 era. It remains unclear whether COPD patients are at increased risk for contracting SARS-CoV-2. However, during periods of high community spread, spirometry should be reserved only for essential need. COPD patients should be instructed to practice basic infection control measures, which include: social distancing, hand washing and correct mask wearing. It is also important for COPD patients to remain up to date on their routine influenza vaccinations as well as other appropriate vaccinations like the Pneumovax. Current evidence-based treatment regimens for COPD continue to be indicated for stable COPD as well as treatments recommended for exacerbations. In COPD patients suspected for COVD-19, testing is recommended. Pharmacological therapies continue to evolve, but are appropriate for COPD patients.
For COPD patients who are COVD-19 positive by SARS-CoV-2 PCR:
- Mild COVD-19: protective strategies, COPD exacerbation protocols, low-intensity exercise
- Dyspnea and infiltrates on CT scan: controlled oxygen; systemic steroids, remdesivir, anticoagulation
- ARDS: NIV, high flow nasal oxygen therapy (HFNT), invasive mechanical ventilation (IMV), prone positioning, anticoagulation
For the convalescent COVID patient, home exercise and pulmonary rehabilitation are recommended. Oxygen therapy evaluation should be carefully evaluated and reassessed frequently.
What does this mean for the PR Professional?
COVID-19 has and will continue to impact all of us in the PR world. This scientific report provides one more evidence-based recommendation for pulmonary rehabilitation for the post-COVID-19 patient. While this publication focuses on the patient with pre-existing COPD, we are seeing that COVID-19 is becoming a significant diagnosis for new referrals to PR programs.
Halpin DM, Criner GJ, Papi A, Singh D, Anzueto A, Martinez FJ, Agusti AA, Vogelmeier CF on behalf of the GOLD Science Committee. (2021). Gold initiative for the diagnosis, management and prevention of chronic obstructive lung disease. The 2020 Gold science committee report on COVID-19 and chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine 203 (1): 24-35.
Public access to the article PDF: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781116/pdf/rccm.202009-3533SO.pdf