title: Home treatment of exacerbations of chronic obstructive pulmonary disease by an acute respiratory assessment service.
abstract: BACKGROUND
  Exacerbations of chronic obstructive pulmonary disease are a major cause of hospital admissions, but do not require intensive investigation or complex therapy. We investigated the suitability of home care for severe uncomplicated exacerbations.
  
  
  METHODS
  Over 3.5 years we assessed 962 patients with exacerbations of chronic obstructive pulmonary disease after referral to a hospital respiratory department by their family physicians. All patients had chest radiographs, oxygen-saturation or arterial-gas analysis, spirometry, and physical assessment. Unless admission was thought to be essential, patients were allowed home with a customised treatment package. Each patient was visited daily by a respiratory nurse who monitored progress and treatment compliance and provided education and reassurance.
  
  
  RESULTS
  145 (15%) of 962 required admission at initial referral and 115 (12%) were admitted later. 653 (68%) patients were managed entirely at home and 49 (5%) were referred inappropriately. One patient died at home. All patients had severe disease with a mean forced expiratory volume in 1 s of 1.02 L and 395 (41%) had required hospital admission in the previous year.
  
  
  CONCLUSIONS
  After formal assessment in a hospital respiratory unit, many patients with exacerbations of chronic obstructive pulmonary disease can be treated at home by respiratory nurses.
authors.affiliation: Department of Respiratory Medicine, Glasgow Royal Infirmary, Alexandra Parade, UK.
authors.forename: J H
authors.initials: JH
authors.lastname: Gravil
authors.forename: O A
authors.initials: OA
authors.lastname: Al-Rawas
authors.forename: M M
authors.initials: MM
authors.lastname: Cotton
authors.forename: U
authors.initials: U
authors.lastname: Flanigan
authors.forename: A
authors.initials: A
authors.lastname: Irwin
authors.forename: R D
authors.initials: RD
authors.lastname: Stevenson
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003152:Community Health Nursing / Q000458:organization & administration*; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000175:diagnosis* / Q000628:therapy*; D008875:Middle Aged; D009730:Nursing Assessment; D015403:Nursing Evaluation Research; D010343:Patient Admission; D017060:Patient Satisfaction; D015397:Program Evaluation; D012017:Referral and Consultation; D012606:Scotland; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires