On Wednesday 11 March 2020, the World Health Organization declared that COVID-19 could be characterised as a pandemic. People with certain underlying health conditions are at increased risk of severe illness from COVID-19, and are among those advised to be particularly stringent in following social distancing measures.1 Patients are being advised to use telephone or online services to contact their GP or other essential services. In these challenging times, it is more important than ever that patients are able to self-manage their chronic conditions, and in this issue of Guidelines in Practice chronic conditions are a key theme.

People with chronic obstructive pulmonary disease (COPD) are among those deemed to be at increased risk. In November 2019, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) published its 2020 update to the global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. There have been no significant revisions of previous recommendations; however, the 2020 report advocates a more holistic and comprehensive approach to the management of COPD, with increased emphasis on self‑management. Professor David Halpin highlights key learning points for primary care from the updated report. It is also important to consider how patients are kept up to date with the latest advice about COVID-19.

Although not on the at-risk list for COVID-19, chronic pain is a major clinical challenge and has a significant physical and psychological impact on affected individuals. In August 2019, the opioids section of the SIGN guideline on the management of chronic pain was updated to reflect changes in evidence around potential harms and limited long-term efficacy. The updated guideline places more restrictions around indications and duration of opioid use, and recommends that opioids should not be used as a single strategy in chronic pain management, but as part of a wider plan that includes other strategies such as physical and behavioural therapies. 

Professor Lesley Colvin and Professor Blair Smith outline key learning points: know what the evidence says about opioid use; prescribe opioids in line with restrictions; consider non-pharmacological management strategies; assess suitability and monitor carefully when prescribing strong opioids; and use non-pharmacological approaches and support self-management.

Opioids highlighted in dictionary

Key learning points: SIGN chronic pain—opioids

Professor Lesley Colvin and Professor Blair Smith

Eczema is another common, chronic condition that can have a significant impact on a patient’s quality of life. In 2019, the Primary Care Dermatology Society (PCDS) updated its primary care treatment pathways for eczema in adults and children. The pathways focus on the ‘ABC’ of eczema management (avoid triggers, bland moisturisers, control inflammation), and include details about how to manage specific variants of eczema that may occur in these respective groups.

Dr Kash Bhatti distils key learning points from the treatment pathways including assessing the severity of symptoms, asking about previous treatments, applying the ‘ABC’ principles, taking a holistic approach, and referring patients to secondary care. It is also worth noting that the British Association for Dermatologists has issued a statement on dry skin and frequent handwashing to reduce COVID-19 risk,2 which provides helpful management tips that may be useful for patients with existing skin conditions.

Reflux in infants is common but it can be challenging to distinguish between what is considered normal and when symptoms become severe enough to merit treatment for gastro-oesophageal reflux disease (GORD). Dr Jennifer Parkhouse provides 10 top tips for identifying and managing GORD in children. Dr Parkhouse discusses normal and red flag symptoms, how to examine the child, alternative diagnoses, when (and when not) to offer medication, further investigations, and when to refer. 

And finally, in this month’s View from the ground Dr Punam Krishan describes her journey as a portfolio GP.


  1. Public Health England. Guidance on social distancing for everyone in the UK and protecting older people and vulnerable adults. PHE, 2020. Available at: www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people (accessed 18 March 2020).
  2. British Association of Dermatologists. Covid-19 (Coronavirus): Statement on dry skin and frequent handwashing to reduce Covid-19 risk. BAD, 2020. Available at: www.skinhealthinfo.org.uk/statement-on-coronavirus-and-skin-disease-affecting-the-hands/ (accessed 18 March 2020).