COPD Exacerbation Managed with At-Home Respiratory Support

Executive Summary

This case study examines how AtHomeCare’s comprehensive home-based respiratory support program enabled a 72-year-old woman with severe COPD to avoid hospitalization during an acute exacerbation. Through timely deployment of BiPAP therapy, oxygen concentrator setup, and daily respiratory therapist visits, AtHomeCare successfully managed the patient’s condition at home, resulting in improved clinical outcomes, enhanced quality of life, and significant cost savings compared to hospital-based care. This case demonstrates AtHomeCare’s expertise in managing complex respiratory conditions in home settings and highlights the potential of home-based respiratory support as an effective alternative to hospitalization for select patients.

Patient Background

Mrs. Gupta, a 72-year-old retired teacher, had been living with severe COPD (GOLD Stage 4) for 8 years. Her medical history included hypertension, coronary artery disease, and type 2 diabetes. She lived with her husband in a third-floor apartment in Delhi and required assistance with activities of daily living due to her respiratory limitations. Her medication regimen included tiotropium bromide, salmeterol/fluticasone, and albuterol as needed, along with medications for her other conditions.

Despite being on maximal medical therapy, Mrs. Gupta had experienced three hospitalizations for COPD exacerbations in the previous year. Each hospitalization lasted 7-10 days and required intensive respiratory support, including non-invasive ventilation. Her quality of life had significantly declined, and she had become increasingly housebound due to fear of exacerbations and breathlessness.

One evening, Mrs. Gupta developed increased shortness of breath, productive cough with purulent sputum, and wheezing. Her husband contacted AtHomeCare’s emergency helpline, which had been set up as part of her ongoing respiratory management plan. AtHomeCare’s respiratory therapist conducted an urgent assessment and determined that Mrs. was experiencing an acute exacerbation that would typically require hospitalization. However, given her history and the family’s strong preference for home-based care, AtHomeCare implemented a comprehensive home-based respiratory support program to manage the exacerbation at home.

AtHomeCare’s Assessment and Intervention

AtHomeCare’s respiratory therapist conducted a comprehensive assessment at Mrs. Gupta’s home within 30 minutes of the emergency call. The assessment followed Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for COPD exacerbation management and included:

• Respiratory Assessment: Respiratory rate of 28 breaths/minute, oxygen saturation of 85% on room air, use of accessory muscles, and difficulty speaking in full sentences. Arterial blood gas analysis showed pH 7.32, PaCO2 55 mmHg, PaO2 55 mmHg, HCO3 30 mEq/L, indicating acute respiratory acidosis with hypercapnia.
• Cardiovascular Assessment: Blood pressure 160/90 mmHg, heart rate 110 bpm, regular rhythm. ECG showed sinus tachycardia with no acute changes.
• Symptom Assessment: Modified Medical Research Council (mMRC) dyspnea scale score of 4 (breathless when dressing or undressing), COPD Assessment Test (CAT) score of 35, indicating high symptom burden.
• Sputum Analysis: Purulent sputum with increased volume, suggesting bacterial infection. Sputum culture later grew Haemophilus influenzae.
• Home Environment Assessment: Assessment of the home environment for suitability for respiratory care, including ventilation, space for equipment, and caregiver support.
• Psychos

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