The usefulness of home medical appointments during the COVID-19 pandemic in Chronic Respiratory Diseases

Abstract

Introduction: During the COVID-19 pandemic, teleconsultation was used for most non-COVID-19 patients; however, in some patients, it was imperative to provide immediate face-to-face care. Aim: To evaluate the usefulness of home medical consultations (HMCs) in patients with chronic respiratory failure (CRF) and neuromuscular (NM) diseases. Methods: Retrospective analysis of the HMCs performed between June and August 2020. Patients9 demographic and clinical data were evaluated. Medical observation, the results of the tests performed [SpO2, TcCO2, ABG, pulmonary function tests (PFT)] and the therapeutic changes were analyzed. Results: Twenty-two HMC, 13 females’ patients, median age 63.3 years. The main diagnoses were NM disease (n=8), COPD+CRF (n=7), and multifactorial CRF (n=7). All patients with COPD and multifactorial CRF had dyspnea, mMRC ≥ 3 (n=13). They were under NIV (n=4), LTOT (n=1), NIV+LTOT (n=6) and high-flow nasal oxygen (n=1). PFT were performed in 9 cases (mean FEV1 34.3±9.3%), ABG in 10 cases (mean of PaCO2 46.1±9.1 mmHg), and pulse oximetry in all patients. Regarding NM patients, 6 had motor and 5 bulbar impairment; 3 were NIV-dependent; mean of TcCO2 (n=7) was 37.6±3.5 mmHg; mean vital capacity and mean peak cough flow (n=6) were 2508±1557 ml and 206±149 L/min, respectively. HMCs allowed decisions regarding therapeutic strategies in most patients, including pharmacological changes (n=10), ventilatory optimization (n=7) and de novo indication for NIV (n=5), for PEG (n=1) and for tracheostomy (n=1). Conclusion: HMCs were useful, allowing clinical evaluation and several respiratory assessments, as well as therapeutic changes and the implementation of new strategies.