Respiratory conditions and COVID-19

Respiratory conditions and COVID-19

Last updated 1 Jun 2020

Author: Dr Jacqui Bollmann, Independent Consultant Occupational Physician and Force Medical Adviser, South Yorkshire Police

Reviewed by: Prof Paul Cullinan, Honorary Consultant in Respiratory Medicine, Royal Brompton & Harefield NHS Trust and Professor in Occupational and Environmental Respiratory Disease at the National Heart and Lung Institute, Imperial College London

 

Respiratory condition

 

 

Vulnerability

 

 

references

 

Asthma

Hospital admission in last year

Intensive care treatment ever

 

Likely to be very high

 

 

The evidence clearly shows less vulnerability effect for asthma than initially expected. Those with particularly severe and poorly controlled asthma may be at greater vulnerability.
Asthma

Severe (requiring oral corticosteroid treatment in past year)

Add 4 years
Asthma

Mild (well controlled, no requirement for oral corticosteroid treatment in past year)

Add 1 year
Bronchiectasis

Severe, requiring nebulised treatments or

FEV1 <50%

MRC breathlessness score 3 or more

Two or more exacerbations in past year requiring steroid or antibiotics

Regular daily oral steroid

Home oxygen therapy

Non-invasive home ventilation or BiPAP

Add 7 years
Bronchiectasis

Mild, MRC 1, none of above criteria

No evidence of increased vulnerability
COPD

FEV1 <50%

GOLD 3 or 4 classification

MRC breathlessness score 3 or more

Hospital admission for COPD in past

Two or more exacerbations in past year requiring steroid or antibiotics

Regular daily oral steroid

Home oxygen therapy

Non-invasive home ventilation or BiPAP

Add 7 years
COPD

GOLD 1 or 2 classification

No evidence of increased vulnerability
Cystic fibrosis: all Very high https://www.blf.org.uk/support-for-you/coronavirus/what-is-social-shielding
Interstitial lung disease and pulmonary fibrosis

Limited by breathlessness MRC 3 or above

Previous hospital admission for condition

Two or more exacerbations or flare-ups in past year requiring steroids or antibiotics

Regular daily oral steroid

Home oxygen therapy

FVC <80%, TLco <60%

Pulmonary hypertension

 

Currently taking

Azathioprine

Cyclosporin

Methotrexate

Mycophenylate mofetil

Nintedanib

Pirfenidone

Sirolimus

Tacrolimus

 

Intravenous therapy in past six months with

Cyclophosphamide

Infliximab

Rituximab

Very high https://www.blf.org.uk/support-for-you/coronavirus/what-is-social-shielding

 

https://www.pcrs-uk.org/mrc-dyspnoea-scale

Interstitial lung disease and pulmonary fibrosis

MRC breathlessness score 2 and below, none of the above treatments

High
 Lymphangioleiomyomatosis (LAM) Very high or high Likely to be at least high once a patient has presented clinically, and may well be advised to shield if at an advanced stage or if substantially immunosuppressed.
Other respiratory infection

Past TB

May be increased https://www.europeanlung.org/en/QA-covid-19

post-TB lung damage often puts you at a higher risk of picking up chest infections and so you might be at slightly higher risk of having a chest infection if you were infected with COVID-19

Other respiratory infection

Current viral infection

Unclear, may be increased https://www.europeanlung.org/en/QA-covid-19

individuals can get Covid19 in the presence of other URTI – no data on whether the effect will be increased

Other respiratory infection

Past infection, recovered

Low once well and after 7 days https://www.europeanlung.org/en/QA-covid-19

Previous infections do not increase the risk of more severe infections in future unless the previous infections were due to other diseases (such as severe heart or lung conditions, diabetes or conditions or drugs that suppress the immune system)

Sarcoidosis

Stage III or IV

MRC breathlessness score 3 or more

Two or more exacerbations or flare-ups in past year requiring steroids or antibiotics

Regular daily oral steroid

Home oxygen therapy

FVC <80%, TLco <60%

Pulmonary hypertension

Currently taking immunosuppresants

Very high https://www.blf.org.uk/support-for-you/coronavirus/what-is-social-shielding

 

https://www.pcrs-uk.org/mrc-dyspnoea-scale

Sarcoidosis

Stage II bilateral hilar lymphadenopathy and infiltrates

In remission for eighteen months

Increased
Sarcoidosis

Stage I bilateral hilar lymphadenopathy

In remission for eighteen months

Stage 0 (normal CXR) or I (bilateral hilar lymphadenopathy)

Never required treatment

Low

RELATED CONTENT

Vulnerability levels

Very high (Red)

Risk of severe illness or death if contracts COVID-19. Read more

High (Orange)

Likely to need hospitalisation if contracts COVID-19, with protracted illness and heavy NHS burden. Read more

Increased/Moderate (Yellow)

Increased risk compared with healthy individual but should recover.

Low/Standard (Green)

No greater risk than healthy individual.