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

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.

Key Words: COPD, Home care, Mortality, Rehabilitation, Respiratory failure, Survival

List of Abbreviations: BMI, body mass index, COPD, chronic obstructive pulmonary disease, GP, general practitioner, HC, home care, ICU, intensive care unit, LTOT, long-term oxygen therapy, MIP, maximum inspiratory pressure, MLE, maximum likelihood estimation, NIV, non-invasive ventilation, NS, not significant, SC, standard care