Covid-19 Treatments

the day, if possible. An SpO2 above 93% would be consistent with moderate severity.

Covid-19 Treatments

Budesonide Therapy

Studies have shown inhaled budesonide (Pulmicort) has a modest benefit in reducing illness duration and need for admission. If available, offer to patients who are within 14 days of onset of COVID-19 symptoms and are not taking other inhaled or systemic corticosteroids, and are either: • aged 65 years or older, or • any age with any of the following: • diabetes • heart disease and/or hypertension asthma or lung disease • immunocompromised • mild hepatic impairment • stroke or other neurological problem • obesity.

Dose: 800 microgram twice daily.

Duration of therapy: up to 14 days.

Due to world-wide demand, supply may become a problem. Only supply one inhaler per patient. Consider clinical review if further inhalers are requested.

Provide patient instructions on how to use a turbuhaler device (includes instructional video). https://www.healthnavigator.org.nz/medicines/b/budesonide-for-inhalation/

Do not start inhaled budesonide/formoterol (Symbicort) in place of budesonide (Pulmicort) for this indication. The unnecessary LABA is likely to induce unwanted side effects.

Patients already using an inhaled corticosteroid for a different indication (either alone or in combination with long acting beta agonist [LABA]) should continue to use their regular medication and not switch budesonide.

Ask about allergies before providing any medications.

Investigations

Do not routinely perform blood tests or chest X-ray on community patients for COVID-19 as the benefits of obtaining this information are generally not significant enough to warrant the risk of increased COVID- 19 exposure in the community.

Consider deferring any non-urgent or routine checks until the self-isolation period has been completed.

If blood tests or chest X-ray are deemed essential for management, hospital admission is likely to be appropriate.

• If unsure, seek COVID-19 advice. If other investigations are required (e.g. relating to other illness or injury), seek COVID-19 advice about appropriate investigation and venue.

Community-based investigations are rarely required for COVID-19 positive patients. Seek specialist advice if considering.

Management of co-morbid conditions

Review status of co-morbidities and medication compliance. Ensure the patient has their usual medications and advise about non-contact delivery from pharmacy.

• If taking angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensinII receptor antagonists, encourage good hydration and consider stopping or dose reduction to prevent acute kidney injury if at risk of dehydration. Plan sick day management in patients with diabetes, including those on insulin. Consider whether the household is known to the community nursing or other community healthcare team and advise them of the patient's COVID-19 positive status.