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A Specific Home Care Program Improves the Survival of Patients With Chronic Obstructive Pulmonary Disease Receiving Long Term Oxygen Therapy |
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| Authors: | Maurizio Rizzi Mario Grassi Marica Pecis Arnaldo Andreoli Anna Eugenia Taurino Margherita Sergi Francesco Fanfulla |
| Affiliation: | a Servizio di Fisiopatologia Respiratoria, Ospedale Luigi Sacco, Via Grassi, Milano b Dipartimento di Scienze Sanitarie Applicate, Sezione di Statistica Medica e Epidemiologia, Università di Pavia, Pavia, Italy c Unità Operativa di Pneumologia Riabilitativa, Fondazione Salvatore Maugeri IRCCS, Istituto Scientifico di Montescano, Montescano, Pavia, Italy d Unità Operativa di Pneumologia Riabilitativa, Fondazione Salvatore Maugeri IRCCS, Istituto Scientifico di Pavia, Pavia, Italy |
| 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.ObjectivesTo 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).DesignA 10-year follow-up study with 2 parallel cohorts (HC vs SC).SettingUniversity hospital.ParticipantsOne hundred and eight patients in the HC program and 109 patients managed conventionally.InterventionsThe 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 MeasuresMortality; exacerbation, hospital and intensive care unit admission rate.ResultsOne 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.ConclusionsA disease-oriented HC program is effective in reducing mortality and hospital admissions in COPD patients requiring LTOT. |
| Keywords: | COPD Home care Mortality Rehabilitation Respiratory failure Survival |
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