14 Sept 2020

Managing patients with lung disease at home

On-line rehabilitation for home-based patients works well
One of the consequences of the COVID-19 pandemic is the need to manage very sick people (non-COVID and COVID patients both) while they remain in home isolation. This is particularly important for people who suffer respiratory illness and can no longer attend hospitals for their regular appointments.

A program developed by Monash researcher, Professor Anne Holland, has seen a 20-fold increase in its use globally with a major spike in traffic to the site following promotion by the American Thoracic Society.

Professor Holland, from the Monash University’s Department of Allergy, Immunology and Respiratory Medicine, said that people with lung diseases such as chronic obstructive pulmonary disease (COPD) which affects around half a million Australians (and was exacerbated by last summer's bushfires) require management which can include a twice-weekly visit to hospital for rehabilitation.

“These patients are highly compromised and at risk of getting a serious form of COVID if exposed to the virus so it is imperative that they remain in isolation, so the trip to the hospital for routine care is no longer an option,” Professor Holland said.

The HomeBase program – which is designed for clinicians to assist them with developing at-home rehabilitation programs for people with lung disease – has become even more important, according to Professor Holland, as people who have been infected with COVID-19 and sent home from hospital and ICU will need their respiratory condition managed “as we are yet uncertain as to the long term consequences of the impact on the lungs of coronavirus.”

The program developed by Professor Holland allows for online rehabilitation, by a specialist clinician, of each patient’s condition – with one at-home visit, followed by weekly tele-health meetings, a self-management program of exercise, diet, mental health etc is developed for each patient, while the program allows for monitoring of the patient’s condition remotely.

Professor Holland and her team have published the results of a clinical trial which compared the standard 8-week outpatient rehabilitation model for people with lung disease (with twice-weekly trips to the hospital outpatient clinic) to the new home-based program.

The two groups (166 participants in total) were compared straight after the eight-week trial and again 12 months following the trial completion. The study found that the home base rehabilitation was as good as the outpatient model as determined by an ability to walk for six minutes unaided and other measures.

The at-home program was also cheaper.

According to Professor Holland, there is strong evidence showing the effectiveness of rehabilitative treatment – but less than one in ten patients needing this treatment get access to it, because of cost, access etc.  “There are growing numbers of patients recovering from COVID, many of them with lung issues, and unable to access either a doctor or a hospital – so there has never been a more important time to ensure these people have access to an at-home program.”

See more about the home-based program Professor Holland is involved in, at https://homebaserehab.net/

Burge AT, Holland AE, McDonald CF, et al. Home-based pulmonary rehabilitation for COPD using minimal resources: An economic analysis. Respirology. 2020;25(2):183-190. doi:10.1111/resp.13667

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