COVID-19 has already caused significant disruption to healthcare so far this year and the wider implications are likely to continue for months (and probably, years) to come. Those working in primary care will be at the forefront of dealing with some of the issues. The mental health of both patients and healthcare professionals is a concern. There are people living in isolation who are experiencing chronic loneliness, people coping with grief and loss, and with work or financial worries. Key workers, including healthcare professionals, have faced incredibly challenging times, and some will be experiencing burnout as a result of the extra pressures on the workforce. In terms of physical health, there will be late diagnosis of serious disease because some patients have avoided consulting their GP despite having worrying symptoms, and many services have been on hold. Then there are the long-term complications of COVID-19, about which little is currently known. And there will be more differential diagnoses to consider—are a patient’s symptoms long-lasting effects of COVID-19, or something else? At what point should other possible causes of breathlessness be investigated in a patient who previously had COVID-19? What impact will lung tissue damage caused by COVID-19 have in people with pre-existing chronic respiratory illness? 

Dr Mark L Levy summarises some important changes to the management of asthma following the 2020 update to the Global Initiative for Asthma (GINA) Global strategy for asthma management and prevention. Dr Levy explains why GINA no longer recommends short-acting beta2-agonists for first-line therapy in patients with asthma, and why GINA recommends that all patients with asthma should be treated with inhaled corticosteroids either regularly or as needed. The article includes a number of updated figures from the GINA 2020 report, including one that summarises the approach to diagnosis and initial treatment of people with asthma and/or COPD. Dr Levy also highlights recommendations from GINA about the management of people with asthma during the COVID-19 pandemic. 

Lastly, in this month’s View from the ground, Dr Kathryn Hayman writes about her experience of burnout and how she made changes to her personal and professional life to prevent its recurrence.