Hospital versus home treatment of respiratory exacerbations in cystic fibrosis

BACKGROUND Treatment of respiratory exacerbations in Cystic Fibrosis (CF) is important in slowing disease progression. The treatment may be given either at home or at the hospital. The aim of our study was to compare both treatment settings. MATERIAL/METHODS We retrospectively analyzed data of 139 treatments in 54 CF patients (age range 12-47 y) treated for respiratory exacerbations at the hospital (n = 84) and/or at home (n = 55). Primary outcomes were improvement in pulmonary function tests (PFTs), weight gain and duration of treatment in relation to treatment setting. Secondary outcomes were these same parameters, but in relation to different clinical preconditions and CF-related complications. RESULTS Mean improvement in FEV1 (% predicted) was similar between the hospital and home treatments (14.3 ± 34.4% vs. 14.3 ± 20.2%, respectively; NS), yet treatment duration was significantly shorter at the hospital (9.7 ± 6.7 vs. 16.3 ± 9.1 days, respectively; P < 0.02), especially for patients colonized with Pseudomonas aeruginosa (11.1 ± 5.5 vs. 18.0 ± 11.0 days, respectively; p<0.01). At the hospital, a subgroup of patients with CF-related complications improved their FEV1 significantly more than those at home (13.1 ± 19.4% vs. 1.9 ± 14.9%, respectively; P < 0.02), particularly patients with CF-related diabetes mellitus (CFRDM) (11.4 ± 18.7% vs. 1.7 ± 14.6%, respectively; P < 0.05). Patients tended to gain more weight at the hospital compared to home treatment (1.36 ± 4.6 kg and 0.49 ± 3.6 kg respectively; P = 0.06). CONCLUSIONS Hospital treatment for acute respiratory exacerbations in CF may be superior to home treatment, as indicated by a shorter duration of hospitalization, better improvement in FEV1 in patients with CF-related complications, CFRDM in particular and a trend toward better weight gain.