Long-term home care programmes may reduce hospital admissions in COPD with chronic hypercapnia

E. Clini, M. Vitacca, K. Foglio, P. Simoni, N. Ambrosino
1996 European Respiratory Journal  
Long-term oxygen therapy (LTOT) has been shown to improve survival in chronic obstructive pulmonary disease (COPD) patients. The clinical effectiveness of long-term home mechanical ventilation (HMV) is still discussed, nevertheless both LTOT and HMV are often included in the home care programmes of these patients. To evaluate the effectiveness of home care programmes including either HMV or LTOT, 34 COPD patients were studied. They were admitted to either HMV (Group A: 12 males and 5 females,
more » ... es and 5 females, aged 62±5 yrs), or LTOT (Group B: 9 males and 8 females, aged 62±8 yrs). They were compared to a historical group (Group C: 19 males and 10 females, aged 67±16 yrs) performing only their usual standard LTOT during the same period. Spirometry, maximal inspiratory pressure and arterial blood gas values were assessed at baseline and at 6, 12 and 18 months of followup. Mortality rate and number of hospital and intensive care unit (ICU) admissions and days of hospitalization were also assessed. Four out of 17 (23%) patients in Group A, 3 out of 17 (18%) in Group B, and 5 out of 29 (17%) in Group C died within 18 months. Of the lung function tests, only maximal inspiratory pressure in Group A showed a significant increase in the 18th month (50±4 to 56±7 cmH 2 O; p<0.01). In comparison to 18 months prior to the study, hospital admissions (from 2.2±0.6 to 1.3±1.1 and from 2.0±0.7 to 1.0±0.9 for Group A and B, respectively; p<0.005 for both), and days of hospitalization (from 60±34 to 34±40 and from 55±23 to 18±20 days in Group A and B, respectively; p<0.005 for both) significantly decreased only in the two groups submitted to the home care programme. We conclude that home care programmes may be effective in the long-term treatment of chronically hypercapnic chronic obstructive pulmonary disease patients in reducing hospital admissions. Long-term oxygen therapy (LTOT) has been shown to improve survival in chronic obstructive pulmonary disease (COPD) [1, 2]. Long-term mechanical ventilation through tracheostomy is performed in ventilator-dependent patients with chronic respiratory insufficiency from restrictive and obstructive diseases [3] . Although several studies have reported a favourable effect on daytime gas exchange using nocturnal noninvasive home mechanical ventilation (HMV) in restrictive pulmonary diseases [4] [5] [6] [7] [8] , the long-term effectiveness of such a modality in COPD is still discussed and only uncontrolled trials have been performed [9] [10] [11] . Recently, hospital-based home care programmes have been proposed in the long-term treatment of COPD patients with chronic respiratory insufficiency, with the aim of improving quality of life and reducing hospitalization and cost/benefit ratio, but few data from studies in this field are available [12] [13] [14] [15] [16] . Furthermore, few data are available on the relative role of HMV and LTOT in home care programmes. The aim of this study was, therefore, to assess the effectiveness of a new home care programme including, either long-term HMV added to LTOT, or LTOT alone in chronically hypercapnic COPD patients. Methods Patients We studied 34 patients with severe COPD as defined by American Thoracic Society (ATS) criteria [17], who were recruited from December 1991 to September 1992 by our department and proposed for a controlled pros pective study evaluating the effectiveness of home care programmes including either HMV and LTOT, or LTOT alone. All the patients met the criteria for LTOT [18] and had been on LTOT for at least 18 months. Inclusion criteria were: 1) chronic hypercapnia (arterial carbon
doi:10.1183/09031936.96.09081605 pmid:8866580 fatcat:pif5arxex5hpnaqzyoxx54y5gu