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

Gravil, JH; Al-Rawas, Omar A; Cotton, M M; Flanigan, U; Irwin, Adam; Stevenson, R. D.

doi:10.1016/s0140-6736(97)11048-0

Cited by 125 publications

(88 citation statements)

References 6 publications

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“…Finally, ERA probably indicate a true failure of the supported discharge programme. The percentage of ERA9s in the supported discharge programme (2.2%) was not statistically different from that seen in the control group (1.7%) and lower than that reported by the study of GRAVIL et al [5].…”

Section: Interpretation Of Findingscontrasting

confidence: 70%

Supported discharge shortens hospital stay in patients hospitalized because of an exacerbation of COPD

Sala

Alegre²,

Carrera³

et al. 2001

Eur Respir J

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This prospective, controlled, but not formally randomized study investigates the feasibility and efficiency of an alternative to standard hospitalization for patients with exacerbated chronic obstructive pulmonary disease (COPD), based upon supported discharge with nurse supervision at home.Over a 12-month period, emergency physicians, not directly involved in the study, admitted 205 patients with exacerbated COPD to the authors' respiratory unit. Patients were included in the supported discharge group (n=105) if they voluntarily chose to participate in the programme and lived in the city of Palma de Mallorca (where adequate home support could be provided). Patients not fulfilling these criteria (mainly residents outside the city) served as controls (n=100). Inpatient treatment was standardized in all patients and included oxygen therapy, bronchodilators, antibiotics and steroids.Both groups were comparable in terms of age (mean±sd: 70±10versus65±11 yr for supported discharge and control group, respectively), severity of airflow obstruction (forced expiratory volume in one second 45±18% referenceversus46±19% ref.), comorbidity and socioeconomic status. Length of hospital stay (LOS) in the supported discharge group was shorter (5.9±2.8versus8.0±5.1 days, p<0.001). After discharge, a respiratory nurse visited supported discharge patients at home during 7.3±3.8 days. Only one patient (1%) required hospital readmission during this period of time. The reduced LOS resulted in a lower utilization of hospital beds at any given point in time throughout the study period.Within the framework and potential limitations of this study, the results indicate that the supported discharge programme in Spain: 1) allows a significant reduction in the length of hospital stay of patients hospitalized because of an exacerbation of chronic obstructive pulmonary disease; 2) does not result in an inappropriately increased rate of hospital readmissions; and 3) reduces the utilization of hospital resources.

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Section: Interpretation Of Findingscontrasting

confidence: 70%

Supported discharge shortens hospital stay in patients hospitalized because of an exacerbation of COPD

Sala

Alegre²,

Carrera³

et al. 2001

Eur Respir J

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“…Therefore treatment that improves quality of life and limits hospital admission and relapse, constitutes an important element in reducing the impact of the disease on the patient9s life and in tapering treatment costs. GRAVIL et al [26] reported that many patients can be successfully treated at home after an initial clinical assessment in the hospital. The observations in this study enhance the potential for home treatment for a subset of patients referred to casualty for exacerbations of COPD.…”

Section: Discussionmentioning

confidence: 99%

What is the optimal treatment strategy for chronic obstructive pulmonary disease exacerbations?

Willaert¹,

Daenen²,

Bomans³

et al. 2002

European Respiratory Journal

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What is the optimal treatment strategy for chronic obstructive pulmonary disease exacerbations? W. Willaert, M. Daenen, P. Bomans, G. Verleden, M. Decramer. #ERS Journals Ltd 2002. ABSTRACT: The present study aims to determine whether treating chronic obstructive pulmonary disease (COPD) exacerbations with intravenous steroids and aerosol bronchodilators (group I) is superior to oral steroids and multiple dose inhaler (MDI) bronchodilators with a spacer (group II).Group I received 40 mg methylprednisolone?day -1 intravenously with a decrease to 20 mg after 10 days and a further decrease of 4 mg?4 days -1 . Aerosol therapy consisted of 10 mg salbutamol and 1 mg ipratropiumbromide?day -1 . Group II received 32 mg methylprednisolone orally for 1 week followed by 24 mg?day -1 for 4 days and a subsequent decrease of 4 mg?week -1 . Duovent1 MDI with a spacer was given at a dose of 1.6 mg fenoterol and 640 mg ipratropiumbromide?day -1 . In group I (n=19) forced expiratory volume in one second (FEV1) rose from 0.82¡0.46 to 0.91¡0.47 L and average dyspnoea decreased from 6.0¡1.9 to 4.1¡2.6 within 10 days. The Chronic Respiratory Disease Index Questionnaire (CRQ) score increased from 78¡24 to 90¡24 points after 4 weeks. In group II (n=18) FEV1 increased from 0.70¡0.27 to 0.90¡0.29 L, dyspnoea regressed from 6.2¡2.4 to 2.7¡2.6 and CRQ from 67¡17 to 86¡20. Both groups showed similar results in dropout rate, length of hospital stay and patient satisfaction.In conclusion, the two treatment strategies appear equally effective in treating chronic obstructive pulmonary disease exacerbations, although oral steroids and metered dose inhaler bronchodilators appear associated with a higher risk of hospital re-admission. [8]. Notwithstanding the increase in the number of trials in the last decade evaluating the effect of steroids in COPD, little research has been done to compare orally to intravenously administered steroids when treating an exacerbation in casualty or in patients admitted to hospital.More attention has been given to comparing wet nebulizers to metered dose inhaler (MDI) as a device for bronchodilator delivery in COPD. A meta-analysis by TURNER et al. [9] and numerous other trials have shown the two devices to be equally effective in the treatment of stable [1][2][3][4][5][6][7][8][9][10][11][12] and acute [9] COPD in inand outpatient settings. No difference was reported in the effect of bronchodilation, in pulmonary function tests (PFTs), exercise performance, symptom scores or extra b 2 -agonist use. The degree of bronchodilation was considered to be a reflection of the administered dose rather than the mode of administration.There is no consensus on the optimal route of administration for steroids and the device for bronchodilators. Therefore, a prospective, randomized, controlled trial was conducted to investigate the hypothesis that treatment of COPD exacerbations with oral corticosteroids and MDI bronchodilators, compared to intravenous corticosteroids and aerosol bronchodilators, would not result in different ...

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“…Se invece il paziente eseguiva periodicamente il test spirometrico, il nostro controllo servirà a documentare solo un eventuale peggioramento dell'ostruzione (208).…”

Section: Grado DI Ostruzione Bronchialeunclassified

“…Alcuni trials clinici randomizzati hanno mostrato che, in pazienti selezionati, l'assistenza domiciliare integrata rappresenta una valida alternativa all'ospedalizzazione per la gestione di una riacutizzazione in assenza di acidosi respiratoria (210)(211)(212)(213).…”

Section: Stabilire Un Piano DI Gestione Della Bpco E Delle Sue Comorbunclassified

Monografia Giovani FADOI: dalle evidenze alla pratica clinica

et al. 2018

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La gestione della cardiopatia ischemica stabile: dalle evidenze alla pratica clinicaR. Gerloni, L. Mucci, T. Ciarambino, M. Ventura, V. Baglio, M. Chiuch, F. Saladini, S. Dorigoni, P. GnerreApproccio clinico al paziente pancitopenicoM.C. Pasquini, E. Barbagelata, P. Cavallo, T. Ciarambino, S. Ciarla, S. Deregibus, I. Mascherona, L. Mucci, L. ZanlariManagement dell’ipertiroidismo: dall’evidenza alla pratica clinicaM.R. Poggiano, E. Barbagelata, C. UsaiManagement del paziente con insufficienza cortico-surrenalica: dall’evidenza alla pratica clinicaI. Ambrosino, E. Cristaldi, M.R. Poggiano, P. Gnerre, R. Muscariello, M. VacanteLa gestione del paziente con broncopneumopatia cronica ostruttiva: dalle evidenze alla pratica clinicaI Parte - EvidenzeII ParteC. Cenci, C. Rinollo, T. Ciarambino, O. Para, G. Belmonte, S. Moretti, S. Ciarla, M. Gino, F. Pasin, N. Battino

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

Cited by 125 publications

References 6 publications

Supported discharge shortens hospital stay in patients hospitalized because of an exacerbation of COPD

Supported discharge shortens hospital stay in patients hospitalized because of an exacerbation of COPD

What is the optimal treatment strategy for chronic obstructive pulmonary disease exacerbations?

Monografia Giovani FADOI: dalle evidenze alla pratica clinica

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