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.