E. Clini et al., LONG-TERM HOME CARE PROGRAMS MAY REDUCE HOSPITAL ADMISSIONS IN COPD WITH CHRONIC HYPERCAPNIA, The European respiratory journal, 9(8), 1996, pp. 1605-1610
Long-term oxygen therapy (LTOT) has been shown to improve survival in
chronic obstructive pulmonary disease (COPD) patients, The clinical ef
fectiveness of long-term home mechanical ventilation (HMV) is still di
scussed, nevertheless both LTOT and HMV are often included in the home
care programmes of these patients. To evaluate the effectiveness of h
ome care programmes including either HMV or LTOT, 34 COPD patients wer
e studied. They were admitted to either HMV (Group A: 12 males and 5 f
emales, aged 62+/-5 yrs), or LTOT (Group B: 9 males and 8 females, age
d 62+/-8 yrs). They were compared to a historical group (Group C: 19 m
ales and 10 females, aged 67+/-16 yrs) performing only their usual sta
ndard LTOT during the same period, Spirometry, maximal inspiratory pre
ssure and arterial blood gas values were assessed at baseline and at 6
, 12 and 18 months of follow-up, Mortality rate and number of hospital
and intensive care unit (ICU) admissions and days of hospitalization
were also assessed. Four out of 17 (23%) patients in Group A, 3 out of
17 (18%) in Group B, and 5 out of 29 (17%) in Group C died within 18
months. Of the lung function tests, only maximal inspiratory pressure
in Group A showed a significant increase in the 18th month (50+/-4 to
56+/-7 cmH(2)O; p<0.01). In comparison to 18 months prior to the study
, hospital admissions (from 2.2+/-0.6 to 1.3+/-1.1 and from 2.0+/-0.7
to 1.0+/-0.9 for Group A and B, respectively; p<0.005 for both), and d
ays of hospitalization (from 60+/-34 to 34+/-40 and from 55+/-23 to 18
+/-20 days in Group A and B, respectively; p<0.005 for both) significa
ntly decreased only in the two groups submitted to the home care progr
amme. We conclude that home care programmes may be effective in the lo
ng-term treatment of chronically hypercapnic chronic obstructive pulmo
nary disease patients in reducing hospital admissions.