[General problems posed by the domiciliary treatment of chronic respiratory insufficiency]

Hypoxaemia secondary to chronic bronchopulmonary disease may lead to total invalidity and be complicated by right heart failure. Consistent and meticulous medical care may produce a notable improvement by not smoking, using bronchodilators, mucolytics and physiotherapy. If, despite these measures, frank hypoxaemia persists, then domiciliary oxygen should be considered. The need for prolonged oxygen therapy of more than 15 hours is often countered by the scepticism and lack of discipline of the patient and family. In cases of hypoxaemia which are partially refractory or are associated with hypercapnia prolonged mechanical ventilation with a tracheotomy will ensure considerable salvage in those with severe restrictive defects and right heart failure. The supervision of oxygen therapy requires not only adequate control of blood gases, but also collaboration between the family doctor, the respiratory physician and home visitors such as the nurse or technician.