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Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus
Online ISSN 1827-1723
CONTROVERSIES AND UPDATES IN RESPIRATORY MEDICINE
Division of Respiratory Medicine, University Hospital, Santiago de Compostela University, Santiago de Compostela, Spain
One of the most important future challenges facing health systems is the care of an increasing number of chronic patients. Among chronic conditions, chronic obstructive pulmonary disease (COPD) is particularly relevant because of its high prevalence. Patients with COPD have acute exacerbations (AECOPD) of their condition. Despite the fact that most are treated in the community or remains unreported, it is still the main cause for hospitalizations. AECOPD were found to be independent indicators of poor prognosis. Repeated hospitalizations for AECOPD are implicated in accelerated disease progression. These patients have greater long-term decline in lung function, decreased health-related quality of life (HRQL) and increased morbidity. Although mild episodes are generally reversible, more severe forms of respiratory failure are associated with significant mortality and a prolonged period of disability in survivors. Patients with three or more AECOPD episodes per year were found to have the greatest mortality risk. For all these reasons, care strategies should be found to reduce this burden. Disease management can be broadly defined as a comprehensive strategy for improving overall health status and reducing healthcare costs in chronic conditions. Hospital at home schemes are a recently adopted method of service delivery for the management of AECOPD aimed at reducing demand for acute hospital in-patient beds and promoting a patient centered approach through admission avoidance. These programs are carried out over a long period of one or more years, and include regular home visits, which are usually made by a registered nurse. The nurse-led scheme helps patients to manage their condition at home and provides support and education. Moreover, it may result in early detection of problems and a reduction in hospital admissions.