HOME TREATMENT OF EXACERBATIONS OF CHRONIC OBSTRUCTIVE PULMONARY-DISEASE BY AN ACUTE RESPIRATORY ASSESSMENT SERVICE

Background Exacerbations of chronic obstructive pulmonary disease are a major cause of hospital admissions, but do not require intensive inv estigation or complex therapy. We investigated the suitability of home care for severe uncomplicated exacerbations. Methods Over 3.5 years w e assessed 962 patients with exacerbations of chronic obstructive pulm onary disease after referral to a hospital respiratory department by t heir family physicians. All patients had chest radiographs, oxygen-sat uration or arterial-gas analysis, spirometry, and physical assessment. Unless admission was thought to be essential, patients were allowed h ome with a customised treatment package. Each patient was visited dail y by a respiratory nurse who monitored progress and treatment complian ce and provided education and reassurance. Findings 145 (15%) of 962 r equired admission at initial referral and 115 (12%) were admitted late r. 653 (68%) patients were managed entirely at home and 49 (5%) were r eferred inappropriately. One patient died at home. All patients had se vere 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. Inter pretation 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.