Home versus hospital treatment of acute cystic fibrosis pulmonary exacerbations - Is quality of life really better at home?

Abstract

Background: Home intravenous (IV) antibiotic treatment of cystic fibrosis (CF) acute pulmonary exacerbations (PExs) has become a widespread occurrence, preferred by most patients over hospital treatment. Better quality of life (QoL) has been quoted as one of the main reasons why patients favour home treatment over hospital care.

Patients & Methods: This was a prospective study, which analyzed 181 PExs needing treatment with IV antibiotics in 58 adult CF patients (32 male). FEV1, FVC and QoL scores using Quittner’s CF Questionnaire-Revised (CFQ-R) were recorded at the start (day 1) and end (day 14) of treatment. PExs were classified according to the site where the majority of treatment (>80%) had been delivered (at home or in hospital).

Results: Baseline day 1 FEV1 and FVC values were similar in the 2 groups, but after 14 days of IV treatment significantly greater improvement was observed in the hospital treatment group. Baseline total QoL scores were higher in the home treatment group (mean QoL (SEM) 711.8 (20.5) in the home group and 595.4 (35.8) in the hospital group, P=0.003). However, after 14 days of treatment, changes in the total QoL scores were higher in the hospital group (mean QoL (SEM) 49.8 (17.5) in the home group and 140.9 (16.8) in the hospital group, P=0.001). Consequently, on day 14 values of QoL were similar in the 2 groups (mean QoL (SEM) 742.4 (21.5) in the home group and 747.1 (33.4) in the hospital group).

Conclusions: QoL demonstrated a significantly greater improvement in the hospital group. On day 14 QoL for the hospital group was similar to that of the home group despite possible disadvantages imposed by the confinement in hospital.