Annual General Meeting of the Irish Thoracic Society - IJMS | Irish ...

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SESSION THREE ONE
ANNUAL MEETING OF THE IRISH THORACIC SOCIETY • 11 - 12 November 2005 • WESTWOOD HOUSE HOTEL, GALWAY
Session 3: Poster Discusssion Session
ANNUAL MEETING OF THE IRISH THORACIC SOCIETY • 11 - 12 November 2005 • WESTWOOD HOUSE HOTEL, GALWAY
3
SESSION
SESSION THREE ONE
COPD
3.1
Long term oxygen therapy use in Ireland; audit of a
regional hospital
Introduction
An audit of the use of long-term oxygen therapy
(LTOT) in an Irish Regional Hospital.
Methods
Retrospective review of patients who were initiated
on LTOT at the Midland Regional Hospital Mullingar
between 2002 and 2004
Research
Data from 108 patients was reviewed. The mean age
of the population was 68 years; 54% were male. 33%
of the patients were actively smoking tobacco up until
the time of initiating LTOT. Eighty five of the patients
(79 %) had a diagnosis COPD as the reason for their
hypoxaemia. Only 36% of the patients had pulmonary
function tests performed, though the majority of
patients (85%) had arterial blood gases taken.
3.2
Unmet daily needs of COPD patients
Introduction
The effects of exacerbation of COPD can remain
long after the acute phase has passed. It impacts
not only on lung function but also on Activities of
Daily Living (ADLs) and emotional well-being. One
month following discharge, 30% of elderly patients
still have compromised mobility and 90% are unable
to perform all household chores. Early Supported
Discharge (ESD) schemes for COPD patients attempt
to provide medical, nursing and social support
in their own homes during the acute phase and
many schemes report short term outcomes such as
reduced length of hospital stay. However, it is not
always clear if the longer-term needs of patients
have been addressed.
Method
Review of documentation used by Foyle &
Altnagelvin ESD scheme to assess the effectiveness
of nursing interventions in relation patients longterm
needs.
Results
89 patients’ (46F/43M) records between Nov. 2004
- July 2005 were analysed. Mean age was 68yrs (51-
Very few patients had their LTOT prescribed by GP’s
(3%), the remainder having their oxygen prescribed
by general and chest physicians. All patients had a
back-up cylinder of oxygen provided, and 84% had
concentrators; only a third (36%) had been provided
portable oxygen. Though the concentration of oxygen
had been prescribed in the majority (91%), only 79%
had the duration of therapy specified. 86% of the
patients were followed up in clinic; however, only 42%
of them were re-evaluated for continued need for
LTOT. None of the patients had their LTOT withdrawn.
Conclusion
LTOT is presently not being properly prescribed.
Appropriate follow-up is also inadequate.
85 years), 24% lived alone, 34% never left their home,
36% were on LTOT and 48% had long term assistance
with personal care.
Nurse referrals for Long-term Personal Care = 9%,
for ADL equipment = 60%, for Occupational Therapy
assessment for adaptations =19%, for Specialist
Nursing & PAMs input =15%, for pulmonary
rehabilitation = 27% and miscellaneous referrals =10%.
Conclusions
This review highlighted that nursing follow-up of
patients in their home can identify and address
deficiencies in care and social support for COPD
patients. Therefore, we would recommend that a
home assessment of post exacerbation patients, who
feel disabled, is an essential component of holistic
COPD management.
I Kamal, A O’Brien
Midland Regional
Hospital Mullingar,
Co. Westmeath
A Box, M Logue,
A Kennedy,
M McCloskey, M Kelly,
JG Daly, RA Sharkey
Foyle Trust, Abercorn
Road, Derry, Dept of
Respiratory Medicine,
Altnagelvin Hospital,
Derry
3.3
Lung volume reduction surgery: an unmet need?
Therapeutic options for patients with severe COPD
are limited but lung volume reduction surgery
(LVRS) has been proposed for selected patients with
severe emphysema. The procedure involves the
bilateral resection of diseased lung through a median
sternotomy. There is no established LVRS programme
in Ireland. We report two patients with heterogeneous
emphysema who underwent LVRS urgently following
development of acute respiratory failure.
Case 1
A 48-year-old ex-smoking male was admitted with an
exacerbation of COPD. He had received conventional
treatment including pulmonary rehabilitation. Despite
intensive treatment he failed to improve and proceeded
to bilateral LVRS. He made a successful recovery.
Preoperative and postoperative PFTs are shown.
3.4
Introduction
In Beaumont Hospital, exacerbations of COPD
account of 10% of total medical admissions. These
patients are often ill-prepared for their transition
from hospital to home. Our aim is to identify the
benefits of an assisted discharge programme for
this patient group who were ineligible for our COPD
Outreach Programme.
Method
An initial inpatient assessment was completed
by the Outreach team. An average of two home
visits with follow-up phone calls over a two week
period was carried out. Outcome measures included
spirometry and Borg breathlessness scale.
Emphasis was on medication compliance, education
Case 2
A 53-year-old ex-smoking male was admitted with an
exacerbation of COPD in March 2005. Similarly he had
received conventional treatment including pulmonary
rehabilitation. He had known ischaemic heart
disease. Despite intensive treatment he remained in
respiratory failure dependent on NIV. He proceeded
to LVRS. This was complicated by a post-operative
cardiac arrest. The patient was slowly mobilized but
deteriorated and died 111 days postoperatively.
Both patients had been considered for LVRS electively
but in the absence of an established programme
they only proceeded to surgery when they acutely
deteriorated. We conclude that an elective LVRS
programme is needed in Ireland.
PREOPERATIVE
POSTOPERATIVE
FVC 3.88 (72%) 4.25 (92%)
FEV1 1.57 (42%) 2.87 (76%)
TLCO 13.88 (43.86%) 18.36 (58.38%)
TLC He. Dilution 6.71 (95.05%) 6.39 (90.48%)
FRC 3.59 (103.7%) 3.12 (89.71%)
TLC Body Plethysmography 9.25 (130.9%) 7.06 (99.9%)
ITGV 6.36 (183.6%) 3.65 (104.8%)
The efficacy of an assisted discharge programme for
patients with chronic obstructive pulmonary disease
– a necessary expansion of COPD outreach services at
Beaumont Hospital
and life-style changes including smoking cessation,
coping mechanisms and self management plans.
Results
Over six months (January to July 2005), a total of
24 patients were recruited. 12 Males and 12 Females
with a mean age of 78 (± 8.6). Mean FEV 1
% predicted
- 35% (± 14.2). Median Borg score 0.5 (±1.1). Median
MRC 2. Average length of stay 7.3 days (± 6.1). 80% of
patients, post discharge, required further community
referrals by the team for example: provision of home
oxygen and social services.
Conclusion
An assisted discharge service bridges the gap
between hospital and community by providing a
safe, seamless transition home for COPD patients.
BB Shu, M Connor,
G Lawless, M Tolan,
TJ McDonnell
Depts of Respiratory
Medicine and Thoracic
Surgery St Michael’s
and St Vincent’s
University Hospital,
Dublin
JM Shortt, CC Byrne,
BM Deering, SJ O’Neill,
NJ McElvaney,
RW Costello
Dept of Respiratory
Medicine, Beaumont
Hospital Dublin
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