Follow NICE guidelines on managing severe breathlessness in COVID-19

THE GMC has released a statement encouraging doctors to follow NICE guidance on the use of an opioid-benzodiazepine combination for patients with coronavirus who are suffering moderate to severe breathlessness.

It cites a NICE rapid guideline on managing coronavirus (COVID-19) symptoms (including at the end of life) in the community and states: "It is vital that dying patients are given as much dignity and comfort as is possible.

"To that end, the guideline recommends considering an opioid and benzodiazepine combination for patients with coronavirus who are dying, are distressed and suffering moderate to severe breathlessness."

UK marketing authorisation is currently not applicable for this use of the drugs and some clinicians have expressed worry about how this guideline fits with GMC and MHRA advice about medicines that are unlicensed or used outside the terms of their existing license ('off-label').

The GMC states: "We want practitioners to know that it is entirely appropriate to follow these guidelines and that we would not have concerns about prescribing decisions based upon them.

"These are permissive guidelines and doctors should use their judgment about what is right for the patient in front of them, including on appropriate dosage. Should these drugs be unavailable, clinicians can also use their judgment and available evidence to work outside these specific recommendations and make decisions based on what is best for their individual patient."

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