[Home care of severe COPD].

Home management of patients with severe chronic obstructive pulmonary disease implies to consider in parallel with optimal medical treatment and chest physiotherapy, the status of chronic respiratory failure needing initiation of long-term oxygentherapy. Chronic hypoxemia (PaO2 < or = 55 mmHg) is present with chronic respiratory failure, which may be stabilized under long-term oxygentherapy if oxygen is given at least 15 h/24 h, with long-term improvement of life expectancy and quality of life. With the help of home respiratory care networks which are developed on a large extent in France, it is possible to prescribe in good technical conditions long-term oxygentherapy at home, which is a life-long treatment. Home mechanical ventilation concerns the most severe patients, with unstable chronic respiratory failure, where long-term oxygentherapy fails to prevent acute respiratory failure episode, sometimes also in patients who are waiting on a lung transplantation program.