**1. Introduction**

374 Chronic Obstructive Pulmonary Disease – Current Concepts and Practice

Yohannes, A. M., Baldwin, R. C., & Connolly, M. J. (2005). Predictors of 1-year mortality in

doi:10.1093/ageing/afi163

patients discharged from hospital following acute exacerbation of chronic obstructive pulmonary disease. *Age and Ageing, 34*(5), 491-496.

> Demographic, epidemiological, social, and cultural trends in European countries are changing the traditional patterns of care. The next decades will see increasing rates of caredependent older people and non communicable diseases as the leading cause of chronic illness and disability. The break-up of the traditional large family group and urbanization will also lead to gaps in the care of older or disabled family members. These changes in needs and social structure require a different approach to health and social sector policy and services since a disease-oriented approach, alone, is no longer appropriate. An answer to these issues could be home care, a sustainable approach to prevent the need for unnecessary acute or long-term institutionalization and maintain individuals in their home and community as long as possible providing diagnostic, therapeutic and social support (Tarricone & Tsouros, 2008).

> Home is a place of emotional and physical associations, memories and comfort. Although many people can be happy in assisted-living facilities, retirement communities or nursing homes – and for many people these are better options – leaving home can be disruptive and depressing for some people. Recent trends in health care favour alternatives to traditional hospital care for patients with acute or chronic diseases. Home care used appropriately decreases hospitalization and nursing home use without compromising medical outcomes. Moreover, patients generally prefer to remain in familiar surroundings. Physician support of home care services honors that preference (Levine et al., 2003).

> Chronic Obstructive Pulmonary Disease (COPD) has been the focus of several hospital at home studies, however, most models studied have been early-discharge schemes that employed nursing care, without physician care in the home. There have been fewer studies of substitutive physician-led clinical unit model of hospital at home.

Hospital at Home for Elderly Patients

Italy, prevalence of COPD is 4.5%, on average.

update 2010).

Survey-NHIS, 1999-2009).

with Acute Exacerbation of Chronic Obstructive Pulmonary Disease 377

data agree with results from the BOLD study, a population-based prevalence study including participants from 12 sites worldwide (n=9425), reporting a prevalence of COPD stage II or higher of 10.1% overall, 11.8% for men and 8.5% for women (Buist et al., 2007).

In England the rate of COPD in the population is estimated at between 2% and 4%, representing between 982.000 and 1.96 million people. The diagnosed prevalence of COPD was 1.5% of the population in 2007/08 according to the Quality Outcome Framework (QOF) statistical bulletin. Approximately 835.000 people in England have been diagnosed with COPD in 2008/09. However, it is currently estimated that over 3 million people have the disease and that an estimated 2 million have undiagnosed COPD, among whom it is considered that 5.5% will have COPD at the mild end of the spectrum (NICE guidelines,

Recent available data suggest that a pooled prevalence on spirometric basis is about 9% in European adults, with 4-6% of them suffering from a relevant clinical form of the disease. In

The reported total prevalence of chronic bronchitis in U.S. adults ranged from a high of 55 (2001) cases per 1.000 to a low of 34 (2007). The prevalence of chronic bronchitis appears to have peaked in 2001, followed by a subsequent decline from 2001 to 2007. In 2008, however, there was an increase in the prevalence (44 case per 1.000) compared to the previous year, and this prevalence was the same in 2009 (data from the U.S. National Health Interview

The epidemiology of COPD in five major Latin American cities (São Paulo, Santiago, Mexico city, Montevideo and Caracas) has been provided by the PLATINO project , launched in 2002: rates of COPD range from 7.8% in Mexico city to 19.7% in Montevideo, suggesting that COPD is a greater health problem in Latin America than previously realized (Menezes et al., 2005). COPD is emerging as public health problem also in the Middle Est and North Africa countries. In 2001, the prevalence of COPD in Africa was estimated 179/100.000 and

Currently, in the European Union COPD and asthma, together with pneumonia, are the third most common cause of death, while in North America COPD represents the fourth leading cause of death. Five year survival from diagnosis is 78% in men and 72% in women with clinically mild disease, but falls to 30% in men and 24% in women with severe disease. (NICE guidelines, update 2010). Due to an aging population, increase in COPD prevalence and mortality are expected in the coming decades. The World Health Organization (WHO) has estimated that COPD will be the third leading cause of death for both males and females worldwide by the year 2030, surpassed only by heart disease and stroke (WHO, 2011).

Burden of COPD can also be measured in disability-adjusted life years (DALYs). Worldwide, COPD is expected to move up from the 12th leading cause of DALYs in 1990 to

In the United States COPD accounts for 15.4 million physician visits, 1.5 million emergency department visits and 636.000 hospitalizations each year (Dalal et al., 2011). In Italy, COPD is the fourth highest cause of hospital admission (130.000 admissions every year). In the UK COPD is the second largest cause of emergency admission and the most common cause for emergency admission to hospital due to respiratory disease. One fifth (21%) of bed days

301/100.000 in eastern Mediterranean countries (Lopez et al., 2006b).

the 5th leading cause in 2020 (Lopez et al., 2006 b).
