Home treatment of exacerbations of chronic obstructive pulmonary disease by an acute respiratory assessment service

Lancet. 1998 Jun 20;351(9119):1853-5. doi: 10.1016/s0140-6736(97)11048-0.


Background: Exacerbations of chronic obstructive pulmonary disease are a major cause of hospital admissions, but do not require intensive investigation or complex therapy. We investigated the suitability of home care for severe uncomplicated exacerbations.

Methods: Over 3.5 years we assessed 962 patients with exacerbations of chronic obstructive pulmonary disease after referral to a hospital respiratory department by their family physicians. All patients had chest radiographs, oxygen-saturation or arterial-gas analysis, spirometry, and physical assessment. Unless admission was thought to be essential, patients were allowed home with a customised treatment package. Each patient was visited daily by a respiratory nurse who monitored progress and treatment compliance and provided education and reassurance.

Findings: 145 (15%) of 962 required admission at initial referral and 115 (12%) were admitted later. 653 (68%) patients were managed entirely at home and 49 (5%) were referred inappropriately. One patient died at home. All patients had severe 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.

Interpretation: 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Aged, 80 and over
  • Community Health Nursing / organization & administration*
  • Follow-Up Studies
  • Forced Expiratory Volume
  • Home Care Services / organization & administration*
  • Humans
  • Lung Diseases, Obstructive / diagnosis*
  • Lung Diseases, Obstructive / therapy*
  • Middle Aged
  • Nursing Assessment*
  • Nursing Evaluation Research
  • Patient Admission
  • Patient Satisfaction
  • Program Evaluation
  • Referral and Consultation
  • Scotland
  • Severity of Illness Index
  • Surveys and Questionnaires