Published: 23 February, 2021
Contents
New COPD guidelines published
The Asthma + Respiratory Foundation NZ guidelines for the diagnosis, assessment and management of chronic obstructive pulmonary disease
(COPD) have just been published in the New Zealand Medical Journal. These guidelines are also available on the
Respiratory
Foundation website.
We have updated our 2020 COPD article to reflect the
New Zealand guidelines; changes are minor as the New Zealand guidelines
were largely informed by those released by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the Lung Foundation Australia in 2020,
which formed the basis of our original article.
Bpacnz interactive COPD prescribing tools
bpacnz has published a new COPD tool for treatment escalation or
de-escalation to be used at follow-up, after medicines have been initiated.
This tool is based on the Global Initiative for Chronic Obstructive Lung
Disease (2020) and New Zealand COPD (2021) guidelines. This new tool can be
used in conjunction with our existing treatment initiation tool, conveniently located on the same home
page.
COVID-19 vaccines: FAQ
As the first phase of the nationwide vaccination programme for COVID-19 begins to roll-out, it is likely that patients, and healthcare professionals, will have many questions. The
Immunisation Advisory Centre has put together an information
page covering off the most common queries. Of note, people who have received the Pfizer/BioNTech
vaccine should not have an influenza vaccine within the next two weeks, or any other vaccine, including MMR, within the next four weeks. Two doses of the
Pfizer/BioNTech vaccine are given at least 21 days apart, therefore these restrictions apply when either dose is given. It is recommended that the
COVID-19 vaccine course is completed before receiving influenza or MMR vaccines.
Reporting adverse reactions to COVID-19 vaccines
The Centre for Adverse Reactions Monitoring (CARM) has developed a new form for reporting adverse effects associated with COVID-19 vaccination. Anyone
can submit a report to CARM; the only vaccination currently able to be selected on the form is the Pfizer-BioNTech vaccine, but it is expected that other
vaccines will be added as they become available.
Reports can be made directly on the CARM website or via the adverse reaction reporting tool in your patient
management system. The COVID-19 vaccination form is available here.
Paroxetine supply issue
PHARMAC advise that the Loxamine brand of
paroxetine, a SSRI indicated for the treatment of depression and anxiety, is temporarily out-of-stock.
An alternative brand, Paxine, will be listed from 1 March, 2021 to cover the out-of-stock period (duration currently not specified). Paxine is the
Australian version of Loxamine; the formulations are identical.
Paper of the week: Vitamin D and COVID-19: evidence and recommendations for supplementation
A paper published late last year by The Royal Society presents an argument for vitamin D supplementation for all people in the United Kingdom,
and other countries, to reduce morbidity and mortality from COVID-19 infection. This recommendation is based on evidence of an association between
vitamin D deficiency and increased severity of COVID-19.
Given that vitamin D supplements are generally well-tolerated and relatively inexpensive, this decision seems straightforward in a country such as the
UK that has experienced widespread community transmission of COVID-19 and prolonged lock-downs. However, some may argue that in a country such as New Zealand, where COVID-19 is not
rampant, and previously we have cautioned against unnecessary use of vitamin D supplementation in people who are not at high-risk of deficiency, that a blanket
recommendation is not appropriate. Nevertheless, it would seem prudent to ensure going into winter this year that people who are likely to have low
vitamin D levels receive supplementation. This includes older people who are frail, housebound or living in residential care, people with dark skin
pigmentation or people with obesity, chronic kidney disease, liver failure or another medical condition that affects vitamin D metabolism.
Read more
- The current evidence linking vitamin D deficiency with COVID-19 severity is described as "circumstantial
but considerable"
- The cumulative evidence includes associations with COVID-19 severity and surrogate markers of vitamin D
deficiency such as ethnicity, obesity, age, institutionalisation and geographical area, as well as experimental
models of respiratory pathogens, biological studies of impacts of vitamin D on the immune system and preliminary
reports of COVID-19 severity in relation to historical records of vitamin D levels in hospitalised patients
- The authors recommend widespread population vitamin D supplementation, based on benefit outweighing risks,
at a level of 800 IU/day (with daily dosing); a standard vitamin D supplementation regimen in New Zealand
is colecalciferol 1.25 mg (50, 000 IU), once monthly
- The authors recommend that people who are likely to be vitamin D deficient (e.g. in a high risk category)
should consider taking a higher dose initially
Griffin G, Hewison M, Hopkin J et al. Vitamin D and COVID-19: evidence and recommendations for supplementation.
Royal Society Open Science. Dec, 2020; 7, 12. Available from:
https://royalsocietypublishing.org/doi/10.1098/rsos.201912
This Bulletin is supported by the South Link Education Trust
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