We read with interest the recent papers1 ,2 which report the findings of randomised controlled trials of early supported discharge for patients with exacerbations of chronic obstructive pulmonary disease (COPD). Both found that a proportion of such patients presenting to hospital could be safely cared for at home with respiratory nurse support, without adversely affecting mortality or readmission rates.

A similar service to those described operated for the first time in Sheffield over the winter of 1997/8, supported by government money to ease the demand for beds during the winter. Although this did not involve randomisation, our findings were essentially similar. Unselected patients with exacerbations referred by general practitioners for admission to hospital were reviewed and those fulfilling the British Thoracic Society guidelines3 were offered home treatment. Over a 4 month period 29 of 118 patients (25%) referred were found …