Problem Solvers

Childhood Care Compliance

How providers can help care partners ensure young patients comply with respiratory therapy?

A child visits the physician, is diagnosed with a respiratory-related illness, the physician outlines treatment, and then the HME provider and respiratory therapist work to ensure that the kid sticks to treatment. Assuming all goes well, all these parties coordinate on a regular basis to check and assess patient progress and tailor therapy asneeded.

Not so fast. The problem is that kids don’t always do what they’re told, especially if it’s painful or makes look them different from their peers. Respiratory conditions such as asthma, bronchitis and secondhand smoke-related pneumonias can require daily monitoring and treatment.

“[The illnesses] can be ongoing and can reoccur, especially for kids in homes where the parents smoke,” says Jane Swoboda, registered respiratory therapist at Home Care Medical. “They have twice as many respiratory infections than those in homes with no smoking.”


If the required therapy falls by the wayside, a child can experience adverse effects.

“The answer varies patient to patient, depending on their underlying diagnosis and severity, as well as defining the level of non-compliance,” explains Joseph Lewarski, vice president of clinical affairs at Invacare. “In many cases, worsening of their respiratory symptoms, shortness of breath, increased heart rate, along with the potential of more acute exacerbatations (are the result of non-compliance). In the more severe cases, unplanned physician visits, emergency room visits and potentially, hospital admissions.”

Fortunately, young patients often do seem to understand the gravity of their situation, according to Lewarski.

“In my experience, we saw very little non-compliance in pediatric oxygen cases where there was appropriate medical necessity,” he notes. Still, there are those who just may not realize their issues are not normal and daily medical attention is necessary.

“They will not tell an adult they are feeling bad. They can hide the situation,” Swoboda says. “Early on, we want kids to understand the feelings of being squeezed or somebody hugging them real tight or their little brother sitting on their chest. They need to become familiar with that kind of terminology so that they can tell an adult or their parents how they feel. Sometimes these kids feel like that so much of the time, they think that’s how they are supposed to feel.”

Then there are those children who remain in the environment that aggravates their breathing issues, such as a secondhand smoke environment, dust mites and homes with cockroaches and cockroach feces. Those things can make asthma much worse.

“In those cases you’d want to get allergy zip pillowcases and mattress cases to keep dust mites from getting into the lungs and exacerbating the situation,” Swoboda explains. “It isn’t always feasible to buy a new mattress or buy a new pillow, but they can get those covers and zip everything and the dust mites will be more contained.”

Maximizing compliance

An asthma management program is one key to compliance, according to Swoboda.

“What we try do is get the kids in a good asthma management program early on and reason is the outcomes are much better,” she says. “Once they get to the middle school, high school age children will become non-compliant with their therapy because they don’t want to look different.”

What can HME providers do to help maximize compliance?

“Good patient and caregiver education about the disease, the therapy and the technology are central to compliance to oxygen and other respiratory therapies,” Lewarski advises. “Form and fit are also important; insuring the right technology for the right clinical application, while concurrently working to insure the technology employed is appropriate to meet the patient’s specific lifestyle needs, which may include school, work and other outside of the home activities.”

Educating the parents and other children in the house also can go a long way toward compliance.

“These kinds of things can help the parent feel better and helps with the other siblings in the house,” Swoboda says.

Specialized products

HME providers are in a good spot to help these young patients by working with their care partners to supply them with the tools and devices that can help them adhere to their treatment. For instance, therapies for respiratory illness often include peak flow training, in which there is a little instrument that a child takes in deep breath and blows it out really fast.

“That lets the parents know what stage or what condition their lungs are in because if their peak flows go down it tells the parents that they might have to change what they’re doing in their asthma management program,” Swoboda says.

Other treatments includes nebulizers for nebulized medications and meter dose inhalers (MDIs) which help ensure a child gets medication in their lungs.

There are compressors and nebulizers in a variety of shapes and designs, such as animals, teddy bears and cars, aimed at the pediatric population that are designed to will relax and calm children.

“We carry items that are more geared to younger children now — ones that make the peak flow maneuvers in the morning and night a whole lot more fun because kids don’t like to do peak flows necessarily. If they are having trouble, it makes them cough and wheeze and feel terrible,” Swoboda said.

Swoboda described one peak flow meter that is “sneaky” for kids.

“It’s a whistle and you can set this whistle at a certain point where you feel that its close to their personal best. If they blow their whistle and nothing comes out, they know they have to step up their action plan, which is provided by the physicians and tells the parents what to do when they get to certain levels,” she said.

It’s important to remember the stakes are high. According to the Centers for Disease Control and Prevention, asthma is a leading chronic illness among children and youth in the United States. In 2007, 5.6 million school-aged children and youth (5 to 17 years old) were reported to have asthma, and 2.9 million had an asthma episode or attack within the previous year. Proper care and management of chronic and reoccurring respiratory illnesses early on can go a long way.

“They can have frequent visits to the doctor and hospitalizations as well,” Swoboda said. “Unfortunately children still do die from asthma, and that’s a horrible, horrible thing.”

Fortunately providers can play a role in helping to prevent that through clever solutions that help young patients comply with treatment.

This article originally appeared in the April 2012 issue of HME Business.

About the Author

Cindy Horbrook is the associate editor for HME Business, Mobility Management, and Respiratory & Sleep Management magazines.

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