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.
aServizio di Fisiopatologia Respiratoria, Ospedale Luigi Sacco, Via Grassi, Milano
bDipartimento di Scienze Sanitarie Applicate, Sezione di Statistica Medica e Epidemiologia, Università di Pavia, Pavia, Italy
cUnità Operativa di Pneumologia Riabilitativa, Fondazione Salvatore Maugeri IRCCS, Istituto Scientifico di Montescano, Montescano, Pavia, Italy
dUnità Operativa di Pneumologia Riabilitativa, Fondazione Salvatore Maugeri IRCCS, Istituto Scientifico di Pavia, Pavia, Italy
Correspondence to Francesco Fanfulla, MD, Unità Operativa di Pneumologia Riabilitativa, Fondazione Salvatore Maugeri IRCCS, Istituto Scientifico di Pavia, Via S. Maugeri 10, 27100 Pavia, Italy
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
ABSTRACT