Pediatric Respiratory

Diversify Your HME Business with Pediatric Asthma Services

Child-friendly nebulizer designs have become commonplace, but that is not the only exciting innovation under way in the field of pediatric asthma. The demand for pediatric asthma services from HMEs continues to grow, and with it comes increasing opportunities to diversify your business. There are a variety of products and services to consider.

“We’ve started to see more providers with a sole pediatric focus,” says Lisa Cambridge, director, sales training and clinical development for PARI Respiratory Equipment. There’s a growing market in pediatric asthma as well as in the cystic fibrosis population where nebulization is a big part of the treatment regime, she says.

Simon Says, ‘Meet Market Demands’
Rather than offer a character-designed nebulizer, PARI offers the accompanying mask for nebulizers with a Bubbles the Fish character face and an accompanying book and stickers.

“The mask has been studied to show you get a better amount of medication into the lungs,” explains Cambridge. “The book also helps to educate the parent. The child can read along with the book, and the stickers help the child to personalize the compressor.”

Cambridge adds that the mask interface is important as well as the technique and delivery of the therapy. Education is vital for the optimum outcome, she says. “We try to make that mask a lot more interesting for the patient, as they are then more likely to use it.” PARI also offers a baby conversion mask that rotates so parents can administer therapy while the child is laying down.

PARI’s nebulizers have been used in most of the clinical trials for the most common medications available today. The company has just updated its nebulizer to make it “eye safe,” which prevents aerosol deposits on the patient’s eyes or face.

But the latest equipment designs aren’t just kid-friendly, they’re also provider-friendly. Cash items are another source of revenue in this market. Medline offers a portable battery-powered nebulizer, which Dennis Cook, president of respiratory products, says isn’t reimbursed but has become a popular cash item.

Medline also offers a retail package containing a nebulizer compressor, battery, pediatric and adult masks, a reusable nebulizer circuit, a power adapter and DC power supply, and a carrying bag. Cook emphasizes the benefit to the HME provider in offering pediatric supplies: “When you position yourself as a full-line provider, your referrals are going to increase.”

Move to the Head of the Class
In addition to pediatric-focused products, PARI offers support to the HME provider through self-contained continuing education programs, plus “train the trainer” sessions. When it comes to reimbursement, PARI emphasizes that its reusable nebulizer is reimbursed under Code A7005 versus the lower payment for disposable nebulizers under code A7003. “We really like to partner with the HME and educate them so they can help educate their customers. We want to help the provider grow their business,” Cambridge says.

Part of that education involves keeping up with reimbursement trends. With the cuts in oxygen reimbursement and other areas of the HME business such as mobility, there’s an opportunity to diversity by offering more pediatric services, according to Matt Conlon, director, sales and marketing, Respiratory Drug Delivery, Respironics.

Conlon says that while there has been considerable innovation in terms of MDIs and child-friendly designs, it’s important not to lose sight of the end goal. “Making sure the treatment is effective is more important than a cute design,” Conlon says. “If a traditional nebulizer works faster and more effectively so the child can get back to playing, then I’m sure most parents would prefer it.”

Respironics has recently expanded its pediatric line with the launch of a Pediatric Asthma Management Program featuring the characters Tucker the Turtle and Sami the Seal. The kit includes a low range peak flow meter, a valved holding chamber, instructional DVD and asthma care booklet in English and Spanish, a coloring and activity book, stickers, crayons and a carrying case.

“The coloring book and stickers as well as the educational aids help the patient and the caregiver to better understand why it is important to take their meds,” says Laura Bartelt, associate product manager of MDI drug delivery and monitors. The goal is for HME to receive fewer call-backs and fewer problems.

Additionally, the kit can help differentiate a company with referral sources, Bartelt says. The kit can be customized with an HME name. “If the physician sees that you have extra education and resources available, you will stand out,” she says.

Other manufacturers also are focusing on pediatric education. “The RT is pivotal in having a good education program for pediatric patients and their caregivers, A good, simple program can be tremendously effective, and bodes well for future referrals,” says Cook. He adds that there is a pediatric component to all of the CEU programs available through Medline.

Another manufacturer, Monaghan Medical Corp., is about to launch The Asthma Management Program featuring Doc Monaghan. The program comes with a video, coloring book, two workbooks—one for the children and one for adults. Celeste Belyea, RN, RRT, is a respiratory therapist at Florida Hospital, in Ormond Beach, Fla. She wrote the adult/parent guide for the program.

“In the parent’s workbook, we tried to describe what asthma does in the lung itself and what happens when those airways start to close. We tried to describe what each medication is for and stressed the importance of taking meds every day, even if the child feels good.”

Belyea believes that the key for HME providers is following up and asking the right questions about administrating the treatment and the presence of triggers such as smoking and pets. She recognizes that there isn’t one answer or one program but says the Doc Monaghan program is an excellent introduction. “It’s important to get the parents and children involved, especially when they go to school.”

Imagine Yourself King, Dilly Dally
For those providers considering something completely different, there are unique products for asthma sufferers coming to the market. These include the Airsonett Air Shower. This Sweden-based company has sold the product primarily to Swedish children and hopes to replicate its success in the United States.

When an allergic asthmatic is laying down in the bed, about 70 percent of exposure to allergens is created during the night via the bedding, Airsonett CEO Dan Kristensson says. It is not sufficient to just clean the air in the room, which he says a number of clinical studies have proved. The allergen reservoir—or source of the allergens—is within the bed area.

The Air Shower product is completely different from a typical air purifier. A traditional air cleaner attempts to affect the entire room, but there remain zones of unfiltered air. With the Air Shower, the air is supplied at low velocity so there is no turbulence. The air is also cooled slightly so it falls very gently. “We create a very stable, distinct zone of treated air,” Kristensson says. “It is a concentrated treatment where the patient needs it most.”

Airsonett has conducted extensive clinical research and is currently doing a study that measures the quality of life and the lung function of the most severe pediatric asthma patients between the ages of 12 and 33, with an emphasis on ages 12-19. The company’s prior research, which is available on its Web site,, demonstrated a significant reduction in symptoms, and one boy who was a severe asthmatic was able to reduce his medication by 70 percent.

As the prevalence of pediatric asthma continues to increase — there are nearly 5 million asthma sufferers under the age of 18— HME providers should experience a growing demand for their expertise, patient care and products to enable sufferers to raise their quality of life.

This article originally appeared in the Respiratory Management March/April 2007 issue of HME Business.

About the Author

Deborah Cooper is the former Respiratory Management editor.


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