The current coronavirus disease 2019 (COVID-19) health crisis has presented several challenges to the management of many health conditions, including respiratory diseases. In an article published in CHEST, researchers describe the challenges some healthcare providers are encountering in treating patients with chronic obstructive lung disease (COPD) during the pandemic as well as the potential solutions that are being implemented.
In patients with COPD, it may be essential to evaluate for COVID-19 as a trigger of acute exacerbations of COPD (AECOPD). However, because of the hesitancy to treat COVID-19 with steroids while virus testing is pending, it can be challenging to know when or if to implement routine corticosteroids for AECOPD. Currently, the potential harm of steroids to patients with COVID-19 has not been well established, and the use of oral steroids in the presence of the infection remains controversial. However, COPD guidelines state that oral and/or inhaled corticosteroids should be continued as maintenance or for treatments of AECOPD during the pandemic.
Patients with COPD may be at risk for decreased access to medications during the pandemic because of the global shortages of many classes of inhaler medications. The likely contributor to this shortage is the increased need for albuterol and other inhaler therapies for hypoxic respiratory failure in patients with COVID-19. Quarantine restrictions have also disrupted the supply chain and therefore, have likely contributed to reduced patient access to much-needed COPD therapies. The rise in unemployment and loss of employee-sponsored health insurance coverage has also caused COPD medications to become unaffordable for some patients.
Several health systems have started to implement guidelines that recommend preserving prescription inhaler therapies for patients with COPD who are most likely to benefit from their use. Additionally, a generic albuterol inhaler has been approved by the US Food and Drug Administration in response to drug shortages related to COVID-19. Telehealth visits have also been increased during this time to monitor management and exacerbations of COPD, among other health conditions. Further at-home acute care and remote patient monitoring models are being built to support patients with COPD during the current health crisis.
Self-management programs, while helpful for patients with COPD, may need to be modified during the COVID-19 era. For example, pulse oximeters may be a useful at-home self-monitoring tool for patients with COPD that can be used to monitor their disease and need for urgent clinical evaluation.
While COVID-19 posits different challenges for the management of COPD, according to the authors, the pandemic also “presents opportunities to rethink our models of care, improve remote patient monitoring, and implement earlier treatment at home through novel models of virtual care.”
Press V, Gershon A, Sciurba F, Blagev D. Concerns about COVID-related collateral damage for patients with COPD [published online May 28, 2020]. CHEST. doi: 10.1016/j.chest.2020.05.549