Seen this published Friday about Shielding

[LDloveslattecoffe]

digital.nhs.uk/coronavirus/...

digital.nhs.uk/coronavirus/...

See Annex D and E

Can anyone translate EmmaF91 perhaps??

Rule 3: Respiratory

This rule is to identify patients with severe asthma Patients or severe Chronic Obstructive Pulmonary Disease (COPD)

Identification of patients with severe asthma was defined as taking regular or continuous courses of prednisolone, alongside ICD-10 coding.

The usual medicines prescribed for patients with asthma are classified under BNF sections 3.1, 3.2 and 3.3. Many of the medicines within these BNF sections are also prescribed for patients with Chronic Obstructive Pulmonary Disease (COPD).

Since PCPM data does not include indication for prescribing, it is not possible to differentiate all prescribing within BNF 3.1 and 3.2 between asthma and COPD.

Patients likely to have severe asthma were identified, using medicines data, by the following methodology:

a. Patients with asthma were identified as being prescribed Long acting beta2-agonist (LABA) as either a LABA or in combination with an inhaled corticosteroid (LABA/ICS) OR prescriptions for a leukotriene receptor antagonist (e.g. monteluekast).

Sub paragaphBNF code

Leukotriene Receptor Antagonists030302

A list of LABA and LABA/ICS medicines (presentations) used in the analysis is detailed in annex D. Formulations indicated only for COPD were excluded (Indacterol; Olodaterol).

b. From the above list of patients, those who had been dispensed 4 or more prescriptions for prednisolone between July 2019 and December 2019 were identified and considered to have severe asthma.

Chemical substanceBNF code

Prednisolone0603020T0

Due to time constraints more detailed analysis of the quantities of prednisolone per prescription (such as number of tablets) was not possible.

Whilst PCPM data does not include medicines prescribed and supplied by secondary care there can be a reasonable assumption that the majority of the management of asthma and COPD is undertaken in primary care via FP10 prescriptions.

In order to identify regular or continuous prescribing of prednisolone (defined as 4 or more prescriptions), analysis of the full 6 months data was necessary. Patients who commenced regular or continuous prednisolone recently (for example, October onwards) may not be included.

Because of the method of identifying patients with asthma, the data will include patients who have COPD and have also received 4 or more prescriptions for prednisolone. However, removing the patients identified in COPD analysis will have reduced the number (see below).

Patients who were likely to have severe COPD were identified, using medicines data, by

a. prescriptions for a Long Acting Beta Agonist (LABA) and a Long Acting Muscarinic Agonist (LAMA) and an inhaled corticosteroid (ICS) in either November and/or December 2019.

NB: prescribed as either 3 separate medicines, combinations of single and dual / combination medicines or as triple therapy.

A list of medicines used in the analysis is detailed in Annex E.

OR

b.Patients who have had a prescription for Roflumilast most recently in November 2019 and/or December 2019.

Chemical substanceBNF code

Roflumilast0303030B0

For more details on the methodology see the Gold COPD resource

[Swimmingaddict]

Table 2 in section 4 is also interesting as it says anyone prescribed medicine to treat severe asthma in the last 6 months but doesn’t specify that it has been clinically diagnosed. I haven’t had a letter but have been taking Fostair 200/6 for the last 6 months and Montelukast for a year. I am going to have to contact my GP, not looking forward to that!

I don’t want to be shielded, but I don’t want to be a statistic.

[haggisplant in reply to Swimmingaddict]

Same here, only Fostair 200/6. With spring air though we’d planned to try 100/6. No letter, not keen on shielding as have young children.,

[Swimmingaddict in reply to haggisplant]

I was told by resp cons that I would stay at this dose for about 12 months before stepping down. I saw him March 11th and haven’t had a copy of his letter to GP, so the delay isn’t helping me. My view of my GP is not good!

[Xiave]

I'm on Fostair 200/6 2*2, Qvar 100 2*3, Montelukast 10mg - and I'm also fairly sure I had more than 4 courses of prednisolone between July and December 2019, but I haven't had a letter. I guess I'll also have to contact my GP...

[Jojox87x]

Does the above mean you have to be on one of the inhalers ASWELL as being prescribed 4 recent courses of steroids? X

[Js706]

Its basically the medicines that they've been looking at to identify people who may need to undertake shielding for their asthma or COPD. Its the codes for medical prescriptions that staff will have used to identify patients with those diagnoses - some (like having enough courses of prednisolone in the time frame stated or being on constant prednisolone for example) will have automatically received shielding advice.

But having all the patients identified then means that GPs etc can review cases to check that people haven't been missed off - like some people have had multiple courses of prednisolone recently that fall outside the first time frame. But this means some people might have to wait longer to receive that advice as its a massive undertaking. Likewise it seems like being on a medication on the list doesn't necessarily guarantee receiving a letter as it will all form part of the overall clinical picture, which GPs can review.

I know its a really stressful time and people want to find out what they need to do but these guidelines are for use by clinical staff and they will have the right training to interpret them and send out appropriate advice.

That's also why the government said that if you feel you should have received the shielding advice but haven't heard anything by tomorrow (in England, other parts of the UK are behind) you should contact your GP or clinical team if under a consultant to see if you're considered in the extremely vulnerable group.

[Jojox87x in reply to Js706]

Thank you! It’s all so confusing! My GP told me I don’t need to shield but definitely shouldn’t be going to work (I work in a hospital, currently taking Relvar 184/22). But without written clarification looks like I’ll be going back! X

[twinkly29 in reply to Jojox87x]

Maybe your GP would provide some kind of evidence for you saying that you shouldn't be working in that environment?

[Jojox87x in reply to twinkly29]

I think I’ll email the surgery tonight and ask if they can! It’s so hard to know what to do x

[Js706 in reply to Jojox87x]

Its definitely worth contacting your GP if you're stuck in a position like that! Is there any way you would be able to work from home? Or in a less risky area/non clinical work?

Have you spoken to occupational health?

[Jojox87x in reply to Js706]

Thanks I’ll email hem them tonight. My manager is in agreement that I shouldn’t be at work and is trying to facilitate me working from home calling patients etc, but HR are now saying unless symptomatic we can all work 🙄

Will call occ health as well thank you

[Wilkesy]

Can anyone help me- I am on omulizumab, tiotropium, azithromycin and relvar . Haven’t had 4 courses of pred in the time frame. No text or letter. But surely biologics are treated as severe and in this group? If anyone knows, I’d be so grateful.

[LDloveslattecoffe in reply to Wilkesy]

According to the announcement tonight they have sent 1 million out of the 1.4 million so probably best to ask GP tomorrow.

Our surgery website has an online appointment so you can ask that way reply by 6pm following day

[ccccc]

Like many I met the criteria but haven't had a letter - I've just found this - you can register if you are in the extremely vulnerable category tell them your food/medicine needs etc

gov.uk/coronavirus-extremel...