Original article
A Specific Home Care Program Improves the Survival of Patients With Chronic Obstructive Pulmonary Disease Receiving Long Term Oxygen Therapy

https://doi.org/10.1016/j.apmr.2008.08.223Get rights and content

Abstract

Rizzi M, Grassi M, Pecis M, Andreoli A, Taurino AE, Sergi M, Fanfulla F. A specific home care program improves the survival of patients with chronic obstructive pulmonary disease receiving long term oxygen therapy.

Objectives

To analyze the influence of a home care (HC) program on outcomes of patients with chronic obstructive pulmonary disease (COPD) receiving long-term oxygen therapy (LTOT) in comparison with outcomes of patients receiving standard care (SC).

Design

A 10-year follow-up study with 2 parallel cohorts (HC vs SC).

Setting

University hospital.

Participants

One hundred and eight patients in the HC program and 109 patients managed conventionally.

Interventions

The HC program consisted of outpatient clinical and functional evaluations every 6 months, and domiciliary assessments by a specific team including a pneumologist, a respiratory nurse, and a rehabilitation therapist every 2 to 3 months or more, as needed.

Main Outcome Measures

Mortality; exacerbation, hospital and intensive care unit admission rate.

Results

One hundred and eight patients entered the HC program and 109 patients were managed conventionally. The 2 groups of patients did not differ for age, sex, body mass index, COPD severity or comorbid conditions. The overall mortality during the follow-up was 63% and the median survival was 96±38 months. The survival curves for HC and SC patients were statistically significantly different (log-rank, −16.04; P=.0001). In the Cox proportional hazards model, inclusion in the HC program was associated with an increased survival rate, whereas comorbid conditions and requirement of mechanical ventilation during the follow-up were associated with a decreased survival rate. During the entire follow-up, HC patients had a lower number of exacerbations/year than SC patients.

Conclusions

A disease-oriented HC program is effective in reducing mortality and hospital admissions in COPD patients requiring LTOT.

Section snippets

Patients

We enrolled 217 consecutive Caucasian COPD outpatients (128 men, age 70±6 years) in the 2-year period from January 1, 1994, until December 31, 1995, on the basis of the inclusion criteria described below. At the time of this study, all the patients were still being cared for (mean time 36.6±10.3mo) by the same respiratory team that performed the study.

For inclusion in the study, patients had: (1) to have a diagnosis of COPD, according to clinical assessment and the results of lung function

Results

All the patients (excluding deaths) completed the follow-up. Neither the daily prescription of oxygen therapy nor compliance to oxygen therapy differed between the HC and SC groups of patients (daily duration 22.2±2h vs 21±3h, respectively; P= NS; compliance to LTOT 90% vs 88% of time prescribed, respectively; P=NS). Likewise, bronchodilator therapy was similar in the 2 groups of patients, as reported in table 2. The number of domiciliary assessments for each year of follow-up were 6.4±3.1,

Discussion

The main finding of our study is that an HC protocol, specifically designed for patients receiving LTOT for chronic respiratory failure related to COPD, is effective in reducing mortality in comparison with conventional care. This increase in survival rate among patients in the HC program seemed to be mainly related to a reduction in exacerbations as well as fewer admissions to the ICU and stabilization of lung function; the need for domiciliary mechanical ventilation appeared to be lower among

Conclusions

The increasing burden of chronic conditions such as COPD, chronic heart failure, or diabetes mellitus has been accompanied by the development of chronic disease management programs that provide continuity of care such that patients' outcomes are improved and unnecessary re-admissions to hospital are avoided. Recently, Pearson et al22 found that a non-specific HC program provided long-term benefits for patients with a range of chronic diseases, but not for those with COPD suggesting that

References (45)

  • S. Stewart et al.

    Trends in hospitalization for heart failure in Scotland, 1990-1996An epidemic that has reached its peak?

    Eur Heart J

    (2001)
  • P.G. Gibson et al.

    Severe exacerbation of chronic obstructive airways disease: health resource use in general practice and hospital

    J Qual Clin Pract

    (1998)
  • I.M. Osman et al.

    Quality of life and hospital readmission in patients with chronic obstructive pulmonary disease

    Thorax

    (1997)
  • A.F. Connors et al.

    Outcomes following acute exacerbation of severe chronic obstructive lung diseaseThe SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments)

    Am J Respir Crit Care Med

    (1996)
  • J.P. Collet et al.

    Effects of an immunostimulating agent on acute exacerbations and hospitalizations in patients with chronic obstructive pulmonary disease

    Am J Respir Crit Care Med

    (1997)
  • C.J. Murray et al.

    The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020

    (1996)
  • B.R. Celli et al.

    The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease

    N Engl J Med

    (2004)
  • Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial

    Ann Intern Med

    (1980)
  • Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysemaReport of the Medical Research Council Working Party

    Lancet

    (1981)
  • K. Miyamoto et al.

    Gender effect on prognosis of patients receiving long-term home oxygen therapyThe Respiratory Failure Research Group in Japan

    Am J Respir Crit Care Med

    (1995)
  • M.G. Seneff et al.

    Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease

    JAMA

    (1995)
  • J. Garcia-Aymerich et al.

    Risk factors of readmission to hospital for a COPD exacerbation: a prospective study

    Thorax

    (2003)
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