Table 1

Caring for patients with COPD and COVID-19

1	There are no data to suggest that COPD is a risk factor for acquiring SARS-CoV-2.
2	In patients with COVID-19, COPD is associated with an increased risk of poor outcome.
3	A COVID-19 chest infection in a person with underlying COPD is likely a very different process from an acute exacerbation of COPD. However, the diagnosis of COVID-19 does not exclude a coexisting AECOPD. Furthermore, treatment of COVID-19 should take the underlying COPD into account.
4	Antibiotics are advisable in patients with COPD requiring hospitalisation for SARS-CoV-2 chest infection, especially when ventilatory support is needed.
5	Bronchodilators administered by pMDI and spacer are preferred to nebuliser treatment in patients with COPD and COVID-19 and respiratory symptoms. We suggest using long-acting bronchodilators, if needed at twice the frequency of maintenance treatment.
6	Nebuliser treatment should be reserved for those patients with life-threatening disease or those unable to use a pMDI and a spacer. Attention should be paid to preventing airborne transmission in such cases.
7	A course of systemic corticosteroids is advisable in patients with COPD and an AECOPD who require hospitalisation for a SARS-CoV-2 chest infection.
8	Regarding the choice of ventilatory support, it is of utmost importance that patients’ wishes and decisions made with regard to ventilatory support and/or ICU admission and intubation are clear.
9	NIV should be offered to patients with COPD and COVID-19 and acute (on chronic) hypercapnic respiratory acidosis. Care should be taken to limit viral spread by using non-vented masks with exhaled air passing a bacterial/viral filter before entering the room.
10	Chronic NIV should be continued in patients with COPD on home NIV when they present with COVID-19. Home treatment might be an option.
11	We suggest HFNC or CPAP with high FiO₂ in patients with COPD and COVID-19 and acute hypoxaemic respiratory failure, if oxygen therapy fails. Care should be taken to limit viral spread by using surgical masks over the nasal cannulas. With CPAP, exhalation can be filtered before entering the room.
12	Rapid intubation and invasive mechanical ventilation should be provided if patients do not respond adequately to non-invasive support, depending on prior discussions and decisions about escalation of treatment.
13	Hospitalised patients with COPD and COVID-19 should be monitored for unintentional weight loss and dietary support should be offered accordingly.
14	The use of airway clearance techniques in patients with COPD and COVID-19 should be provided prudently to reduce the risk of viral transmission.
15	Early mobilisation in patients with COPD and COVID-19 is very important.
16	It is important to offer psychological and spiritual support to patients with COPD and COVID-19 during hospital admission, as well as during follow-up.
17	Pulmonary rehabilitation should be offered to all patients with COPD and COVID-19 after discharge from the hospital, perhaps starting in an alternative form as long as social distancing is still required.
18	We suggest screening all patients with COVID-19, especially after ICU stay, for emotional and functional limitations and to offer rehabilitation when indicated.
19	Timely advance care planning in patients with COPD should be provided, including patient–physician communication about patients’ values, goals and preferences regarding life-sustaining treatments, as well as addressing worries about the dying phase and palliative treatment options. Timeliness and diligence in this are even more important and challenging during this time of COVID-19 pandemic.
20	Appropriate management of symptoms at the end of life in patients with COPD and COVID-19 is crucial, including management of anxiety, dyspnoea and palliative sedation as needed.
21	We suggest considering bereavement care for loved ones of deceased patients with COPD and COVID-19, since they may be at an increased risk for complicated grief.

AECOPD, acute exacerbations of COPD; HFNC, high-flow nasal cannula; ICU, intensive care unit; NIV, non-invasive ventilation; pMDI, pressurised metered-dose inhaler.