We evaluated patients with COPD who were prescribed aerosolized respiratory medications; administered by homecare provider to determine if assessment and education by homecare respiratory therapist (RT)could decrease emergency room (ER) visits and hospitalization by identifying their need for LTOT before a relapse.
Patients were evaluated retrospectively following winter months from April 2003 to April 2004. Inclusion criteria: (1) diagnosis of COPD, (2) chronic airflow obstruction (evidenced by COPD diagnosis), (3) age >/= 65, (4) education by homecare RT (5) receiving LTOT. Patients recieved oximetry at rest, activity, nocturnally; nutritional status and activities of daily living assessed; LTOT based on qualification by an independent testing facility (IDTF). A total of N=56 from a database of N=238 completed the chronic respiratory disease index questionnaire (CRQ) and the transitional dyspnea index (TDI) via phone interview upon entry into the program and again within 6 months to determine if they experienced a relapse (urgent hospital revisit within 6 months because of an acute exacerbation).
Patients who did not relapse (n = 49) showed moderate-to-large improvements in disease-specific QOL across all four CRQ domains (p < 0.001) large positive changes in TDI (p = 0.0001). Patients with a relapse (n = 7) did not have improved CRQ or TDI scores (p = 0.02). Changes in the CRQ dyspnea score and TDI correlated with each other (r = 0.78; p = 0.0001). A control of N=5 with COPD who participated in the program and not prescribed LTOT showed no changes in the CRQ or TDI over 6 months.
The outcomes and magnitude of change in CRQ and TDI scores were correlated. Outpatients treated for a COPD exacerbation with aerosolized medications and education with early identification of need for LTOT by a homecare RT experience significant short-term improvements in QOL and dyspnea.
The use of a homecare RT for outpatient assessment and education of COPD patients can aid to identify the need for LTOT early to prevent rehospitalization following acute exacerbation.
Vernon Pertelle, None.