Chest
Volume 109, Issue 3, March 1996, Pages 741-749
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Clinical Investigations: Home Care
Predictors of Survival in Patients Receiving Domiciliary Oxygen Therapy or Mechanical Ventilation: A 10-Year Analysis of ANTADIR Observatory

https://doi.org/10.1378/chest.109.3.741Get rights and content

Study objective

To analyze predictors of survival for patients receiving home long-term oxygen therapy (LTOT) or prolonged mechanical ventilation (PMV) according to the cause of chronic respiratory insufficiency (CRI) and the patient's physiologic data.

Design

Analysis of a nationwide database (ANTADIR Observatory).

Setting

The national nonprofit network for home treatment of patients with CRI Association Nationale pour le Traitement à Domicile de l'Insuffisance Respiratoire Chronique (ANTADIR): founded in France in the 1980s.

Patients

There were 26,140 patients receiving LTOT or PMV (noninvasive or via tracheostomy) between January 1, 1984 and January 1, 1993 (chronic bronchitis, 12,043; asthma, 1,755; bronchiectasis, 1,556; emphysema, 551; tuberculosis sequelae, 4,147; kyphoscoliosis, 1,574; neuromuscular diseases, 1,097; pneumoconiosis, 919; and fibrosis, 2,498).

Measurements and results

Survival analysis was performed using the actuarial and the Cox's semiparametric model. The mean survival for patients with chronic bronchitis is 3 years. Survival is slightly better for patients with bronchiectasis and asthma and worse for those with emphysema. Patients with kyphoscoliosis and a neuromuscular disease have the longest survival (8 and 6.5 years, respectively). Patients with CRI due to tuberculosis sequelae experience the same survival as COPD patients (3 years). Prognosis is the worst in patients with pneumoconiosis or fibrosis: 50% of these patients die during the year following the beginning of home treatment. The association of an obstructive lung disease worsens the prognosis of patients with kyphoscoliosis or neuromuscular disease and tends to bring the survival rate of the patients with pneumoconiosis or fibrosis closer to that of COPD patients. In COPD, male sex, older age, lower body mass index (RMI), FEV1 percent predicted, PaO2, and PaCO2 are independent negative prognostic factors. For tuberculous sequelae and kyphoscoliosis, female sex, younger age, a high RMI, PaO2, and PaCO2 (and for kyphoscoliosis a higher FEV1/vital capacity [VC] ratio) are all independent favorable prognostic factors. In pulmonary fibrosis, a lower PaO2 and PaCO2 values, a lower VC percent predicted, and a higher FEV1/VC ratio are negative prognostic factors.

Conclusions

The ANTADIR Observatory allows a unique opportunity to analyze long-term survival of a large population with CRI treated at home.

Section snippets

Collection of Information

The organization of the ANTADIR has been described elsewhere and will be presented only briefly.3 Information concerning the patient's characteristics are taken from the Social Security form that is filled in by the prescribing physician. Precise prescription rules exist in France only for oxygen therapy. This treatment is reimbursed if PaO2 under room air is 55 mm Hg (7.3 kPa) or lower at two measurements in a steady state. The minimum interval between the two measurements should be at least 2

Characteristics of the Population

The characteristics of the 26,140 patients included in the study are shown in Table 1. This shows the relative amount of PMV (via a tracheostomy or a nasal or oral mask) and oxygen therapy in each diagnostic group.

Nearly all patients with obstructive lung disease receive LTOT, while PMV largely predominates in patients with neuromuscular diseases. Oxygen therapy is also preferentially prescribed in pneumoconiosis, fibrosis, and mixed lung diseases. Table 2 shows lung function parameters, ABG

Discussion

The organization of ANTADIR Observatory gives us a unique opportunity to examine the long-term evolution of more than 25,000 patients treated at home for CRI. This population represents an important proportion of patients with CRI receiving domiciliary treatment in France over the same period. The information provided from this study differs from those of the Nocturnal Oxygen Therapy Trial and Medical Research Council (MRC) studies.1, 2 It is likely that many of our patients would have been

ACKNOWLEDGMENTS

The authors wish to thank all the Participating associations: AIR, Angers; AVD, Angoulême; DON DU SOUFFLE, Besançon; AVAD, Bordeaux; AIR, Caen; AIRRA, Clermont-Ferrand; ALIZE DE BOURGOGNE, Dijon; AGIR, Grenoble; GHAHR, Le Havre; AVAD, Lille; ALAIR, Limoges; ARARD, Marseille; APARD, Montpellier; AIR, Mulhouse; ARAIRLOR, Nancy; ARIRPLO, Nantes; CARDIF, Paris; ARAI-RCHAR, Reims; AADAIRC, Rochefort; ADIR, Rouen; ADIRAL, Strasbourg; BAARD, Toulouse; SADIR, Toulouse; and ARAIR CENTRE, Tours.

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