A specific home care program improves the survival of patients with chronic obstructive pulmonary disease receiving long term oxygen therapy.
OBJECTIVE
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).


METHODS
A 10-year follow-up study with 2 parallel cohorts (HC vs SC).


METHODS
University hospital.


METHODS
One hundred and eight patients in the HC program and 109 patients managed conventionally.


METHODS
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.


METHODS
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.
Rizzi
Maurizio
M
Servizio di Fisiopatologia Respiratoria, Ospedale Luigi Sacco, Via Grassi, Milano, Italy.
Grassi
Mario
M
Pecis
Marica
M
Andreoli
Arnaldo
A
Taurino
Anna Eugenia
AE
Sergi
Margherita
M
Fanfulla
Francesco
F
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D007558:Italy; D008297:Male; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D010349:Patient Compliance / Q000706:statistics & numerical data; D015397:Program Evaluation; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality* / Q000628:therapy*; D016019:Survival Analysis; D015996:Survival Rate