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

Arch Phys Med Rehabil. 2009 Mar;90(3):395-401. doi: 10.1016/j.apmr.2008.08.223.


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.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Aged
  • Female
  • Follow-Up Studies
  • Home Care Services / organization & administration*
  • Humans
  • Italy
  • Male
  • Oxygen Inhalation Therapy / methods*
  • Patient Compliance / statistics & numerical data
  • Program Evaluation
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive / mortality*
  • Pulmonary Disease, Chronic Obstructive / therapy*
  • Survival Analysis
  • Survival Rate