Volume 6 | Issue 9 | 2020 | Respiratory Medicine
How Covid-19 has affected respiratory care Dr Sarah O’Beirne, Consultant Respiratory Physician, speaks to Niamh Cahill, while Irish Thoracic Society President Dr Aidan O’Brien speaks to Paul Mulholland about how the sudden shifts in Irish respiratory services caused by Covid-19 could have a lasting impact One of the most significant outcomes of the Covid-19 pandemic to date has been the immense changes it has wrought on the delivery of our healthcare services. Given the nature of the coronavirus and its impact on the lungs, respiratory services have been particularly affected. Dr Sarah O’Beirne, Consultant Respiratory Physician at St Michael’s and St Vincent’s University Hospitals, Dublin, spent much of her time during the first wave of the pandemic looking after hospitalised Covid-19 patients, and speaking to Update said that without doubt the pandemic has had a huge impact. “The service has changed so much in the last six months. Like everything else in medicine we’ve all had to completely reorganise our practice. If anything, it’s shown us how we can adapt and adapt quickly. People have worked well together in these challenging times.” She added that following the ‘first wave’ and the initial shutdown of all ‘non acute’ health services, the focus remains on keeping services up and running as much as possible and to try to stop waiting lists climbing further. “Since July services regular have become more normalised and I think a big push at the moment is to provide as much routine care as possible, despite the pandemic, provided it’s safe, to avoid increased morbidity and mortality in the future.”
pulmonary rehab programme, which began during the pandemic.
Dr Sarah O’Beirne
Dr Aidan O’Brien
pulmonary rehabilitation outpatient classes for patients with chronic lung disease, a development that will have a long-lasting impact on the structure of healthcare, Dr O’Beirne believes. Pulmonary rehabilitation is the standard care for patients with chronic lung disease, ongoing symptoms and limitations despite maximised medical treatment. It is a vital component of care, as rehabilitation reduces hospitalisations. A 2018 report found that Ireland has the highest rate of hospital admission with COPD of any country in the OECD. A study, published in JAMA earlier this year, showed that pulmonary rehabilitation within 90 days of a COPD exacerbation reduces mortality. Typically, pulmonary rehabilitation is provided in an outpatient setting with patients participating in a class run over six-to-12 weeks, depending on the programme. It includes an exercise component, as well as a focus on education and behavioural change.
Amid the upheaval and efforts to continue regular care, completely new services for patients suffering from postCovid respiratory symptoms are being developed to offer continuing care to those still affected by the virus.
But group classes for patients with chronic lung disease are not feasible during the pandemic, according to Dr O’Beirne. “So, the standard outpatient pulmonary rehabilitation programme we provided has been on hold since the pandemic began in earnest in March in this country.
Going virtual One of the biggest shifts since Covid-19 emerged has been the move to virtual
“That’s led, as with other services, to a shift towards more virtual pulmonary rehabilitation. We’ve been running a virtual
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“We’ve had several groups complete the programme already and have seen good results with it. This is a programme people do from home where they log into live sessions and complete an exercise component. We also have the educational parts. It’s all done virtually apart from the pre- and post-rehab assessments, which are done in the hospital. It’s a much safer way from an infection control perspective for patients and for staff.” There have been definite improvements in symptoms, quality-of-life scores and walk distance scores in patients who took part in the virtual programme. Dr O’Beirne said the virtual nature of the clinic has helped increase numbers among those who may not have been able to travel to clinics. Despite this, it is evident that virtual clinics are not suitable for all patients, she acknowledged. “The downside is it’s not suitable for everyone. We know from contacting people on our waiting list for the regular rehab programme that only 50 or 60 per cent of them would be suitable to partake in the programme, due to a combination of access to technology, technological literacy and disease severity. “Then there’s also the aspect that for some patients, depending on their condition, it may not be safe for them to exercise at home in a less supervised fashion. “It’s about recognising the limitations of virtual care, while recognising its definite role, particularly when we are in the throes of a pandemic. I think in the long-term it will be a mix of virtual and standard care that we provide people.”
