[Social and housing conditions of patients with chronic respiratory failure treated in the ANTADIR Federation]. / La vie quotidienne et sociale des patients insuffisants respiratoires chroniques sévères pris en charge dans le réseau ANTADIR.

INTRODUCTION: Chronic respiratory failure (CRF) has an impact on quality of life because of respiratory handicap. METHODS: The purpose of this study was to analyse the daily life and social activities of patients with CRF. A questionnaire was addressed to over 9000 patients being cared for in the ANTADIR homecare network, with over a 60% response rate. RESULTS: The data showed that patients were old, and frequently had comorbidity. The predominant diagnosis was chronic obstructive airways disease (COPD) and the number of women in this population continues to increase. Respiratory handicap led to a loss of autonomy, a reduction in social activity and mobility of patients, but the impact differed markedly according to the cause of the respiratory failure, as well as age and social class. A typological study of behavioural characteristics revealed three groups of patients with contrasting profiles. CONCLUSION: These results lead to recommendation for better management of social aspects of patient care in the ANTADIR network.

[Home respiratory care]. / L'assistance respiratoire traitée à domicile.

In 1980, 11,000 French patients were given home respiratory care (HRC); today there are ten times more cases, i.e. about 120,000. There are two principal conditions in this population: chronic severe lung disease (CSLD), treated mainly with long-term oxygen therapy and assisted ventilation, and sleep apnoea syndrome (SAS), treated with continuous positive airway pressure (CPAP), a treatment that first became available in 1985. The mean age of patients with CSLD is currently 67 years and is increasing annually, while for SAS it is 58 years. The constraints of treatment, prescribed for the rest of the patient's life, are incompatible with long-term hospitalization, given the daily length of treatment (12-24 h for CSLD, and 5-8 h at night for SAS). The number of medical and social workers involved in providing these types of treatment requires complex coordination for the patient to be able to benefit from such highly cost-effective medical and technical services. In the case of home respiratory care, France has benefited for almost twenty years from the services of a not-for-profit network that comprises a national coordinating body, ANTADIR, and regional HRC services administered by physicians specializing in pneumology or resuscitation, often from university hospitals.

Organization of home respiratory care: the experience in France with ANTADIR.

In France, home mechanical ventilation (HMV) is mainly organized through the public system, using a national network of 33 Regional Associations for home care of chronic respiratory insufficiency, which are federated on a national basis by The French National Home Care Association for Chronic Respiratory Insufficiency (ANTADIR). Twenty three thousand six hundred and twenty three patients were being treated at home through that organization at the end of 1991, 14,173 of whom received long-term oxygen therapy (LTO), 2,267 were ventilated by tracheostomy, 1,139 had nasal mask ventilation, and 3,322 received nasal continuous positive airway pressure (CPAP). In common practice, the association performs the installation of the respiratory apparatus at home, at no cost to the patient who is covered by the social security for all expenses. At the end of 1991, the total cost of home respiratory care delivered by ANTADIR rose to 78.6 millions US dollars.

[Home treatment of chronic respiratory insufficiency. Sociodemographic aspects of chronic respiratory insufficiency in France. Preliminary results of a survey concerning 3120 patients registered in a district association for assistance to patients with respiratory insufficiency]. / Traitement à domicile de l'insuffisance respiratoire chronique. Aspects socio-démographiques de l'insuffisance respiratoire chronique en france. Résultats préliminaires d'une enquête concernant 3 120 patients inscrits dans une association régionale d'aide aux insuffisants respiratoires.

The observations of the National Association for the Domiciliary treatment of respiratory failure (A.N.T.A.D.I.R.) affords the opportunity for some hard information on the complex problem of chronic respiratory failure in France. The objectives were to perceive the demographic fluctuations of the population, to follow the development of the distribution of health care, to assess the cost effectiveness of the activities and to place the different participants in the overall schema of the system. The initial results on 3,120 patients show one female for every 2.5 males with a mean age of 62.87. Disorders with chronic airflow obstruction account for 60% and restrictive disorders for 20%. Assisted tracheal ventilation (20% overall) was applied, particularly to this latter type, long term oxygen (O.L.D.) 28% or assisted ventilation with a mouthpiece (VAB) to 45% with chronic airflow obstruction. VAB is still widely practised in France but there is a trend towards O.L.D. VAT and VAB use oxygen bottles as a supply while O.L.D. uses nitrogen extraction in 2 cases out of 3. These are preliminary results and it will be interesting to follow the outcome of these techniques of assisted ventilation in the home, so that there efficacy by gathering functional data (particularly blood gases) may be assessed and either the survival curves analysed or the time spent in hospital.