As a consequence of the confinement measures decreed to stop the spread of SARS-CoV-2, much of the face-to-face healthcare for COPD patients has been interrupted. Now, with de-escalation measures on the horizon, the way to recover it is already being considered. ” We have dedicated almost 80% of the effort to COVID-19, both to care for patients who have been admitted for the virus and to follow-up afterwards, ” says Jesús Molina, coordinator of the Respiratory Diseases Working Group at the Spanish Society. Family and Community Medicine (semFYC).
José Luis López Campos, pulmonologist and coordinator of the COPD area of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) agrees on this idea. Dr. López Campos points out that the current situation “has meant a change in the health organization.” And, as Juan Antonio Trigueros, head of the Respiratory Diseases Working Group of the Spanish Society of General and Family Physicians (SEMG) points out, “the pandemic is developing in a seasonal period that is usually compromised for patients with COPD due to the higher incidence of exacerbations [worsening of the disease], generally of infectious origin ”.
Telephone service
These experts agree that most of this care has shifted towards telephone follow-up. Thus, Dr. Molina explains that they are calling when they can to those whose ailment is more serious, although he explains that ” most of the consultations have been made on demand .” Thus, “if patients have a problem or doubt, they call the health center and we will get in touch with them,” he points out. Another important aspect, points out Dr. López Campos, is the importance of differential diagnosis: “Many chronic COPD patients have respiratory symptoms that make it necessary to rule out infection by the new coronavirus.”
Setting the way to act in a post-covid scenario becomes essential. “The recovery of patients must be done practically immediately: they must come for a consultation and carry out a review,” says Dr. Molina. Following this thread, his colleague López Campos considers that “it would be advisable to carry out a pulmonological assessment of the lung health of the patients.” In the case of COPD patients who have overcome COVID-19, Dr. López Campos specifies that it is not clear “what sequelae the virus can leave behind .” It should also be noted that one of the reasons why it is urgent to assess these parameters is because, as Dr. Trigueros recalls, “carrying out respiratory function tests is now inadvisable.” The latter also urges to assess other aspects, beyond the pulmonary state, derived from confinement: “We must observe the decrease in muscle mass, the deterioration of the response to aerobic exercise and the possible appearance of vascular alterations.” To solve the problems that may be detected in this regard, he suggests that a priority be structured “a program of adequate, progressive, adapted physical activity, based on aerobic and strength training.”
After the storm
José Luis López Campos points out a fundamental problem: the sudden appearance of the pandemic has left little time for clinical research on treatments for the new virus. However, from clinical practice, COVID-19 is becoming better known, which allows it to be attacked from different perspectives. One of these specific cases would be that of patients with previous pathologies such as COPD. Beyond the interference of the coronavirus, Trigueros points out that “special attention should be paid to therapeutic adherence [compliance with medication guidelines].” At this point, the individual responsibility of each COPD sufferer is the fundamental factor, since, as Dr. Jesús Molina points out, there have been no problems regarding access to medicines. ” An extension of expiration periods has been enabled in the electronic prescription so that patients can pick up treatments in pharmacies for longer than had been stipulated, ” he explains. Even so, the experts agree, when returning to the consultation it is essential that the doctors check the follow-up of the medication in each particular case and solve the interruptions when necessary.
By Nieves Sebastián
