Providing quality home respiratory care to pediatric patients presents a uniquely rewarding opportunity for HME providers, and may present some community service and marketing opportunities as well. Providing education and follow-up support to anxious families of a child with asthma or other chronic respiratory condition often requires an unusually high commitment of staff time.

However, superior service also provides an opportunity for home care dealers to set themselves apart from the competition with simple, cost-efficient measures that up the ante on standards of service.

Environmental Assessment
A comprehensive environmental assessment of the home is generally outside the scope of care for most providers. HME dealers may see the need for environmental assessment, but they lament the lack of reimbursement for time and materials. A room-by-room assessment of environmental triggers, followed by an in-depth discussion with the family, is at odds with shrinking reimbursement rates and the need to make efficient use of staff time. In fact, the time and attention spent on such an expedition might actually detract from the clinician’s ability to properly focus on teaching the fundamentals of delivering an effective breathing treatment and cleaning and caring for equipment. But that is no excuse to ignore obvious environmental antagonists and address them with the family.

Smoking is perhaps the number one environmental factor that should be addressed with families of children with asthma or other respiratory conditions. Parents should be asked in a matter-of-fact, nonthreatening manner, “Is there smoking in the home?” Parents who smoke often convince themselves that by blowing the smoke the other way, or smoking in the next room, they have eliminated the threat. Just as hospitals have finally begun asking parents if they smoke and informing them about the effects of smoking on children, HME providers need to consistently remind them that smoking affects a child’s health.

While it may be beyond our mission to inspire parents to quit smoking, it is our responsibility to correct any misinformation that suggests second-hand smoke is not harmful to others in the room. Consumers have to hear a commercial message numerous times before they buy a product, and likewise, smokers have to hear the message that smoking is harmful to others in the home. They need to contemplate the change before they begin to modify their behavior. Parents are now being advised that if they feel they can not quit smoking, they should consider smoking outside and wearing a smoking jacket to keep the smoke off their clothes.

Other triggers can easily be identified, and HME providers can give families information about where to look, and how to take basic measures to reduce their children’s exposure to common household asthma triggers.

• Eliminate the source of the trigger. Sources of excessive mold and mildew-causing moisture in the home should be reduced or eliminated. Families may have to weigh the benefits of keeping a beloved house cat against the health costs of having their child started on oral steroids to counteract the constant effects of living with a feline.

• Keep dust levels down. Poor housekeeping can have a huge effect on respiratory health, and there is a clear correlation between dirty urban environments and increased asthma rates in children. Dust mites are a well-known asthma trigger. Cockroaches (specifically their droppings) are a major asthma trigger and may even have a causative role in the disease.

• Make the bedroom a safe space. Air filters have a hard time cleaning the air for a whole house—the volume of air is overwhelming. But a bedroom can be turned into a “clean room” by keeping the door closed, removing the carpeting, banning dogs and cats, and continuously running a high-capacity air filter. The filter can run at higher speeds by day and at a lower, quieter speed at night. A third or more of a child’s day is spent sleeping in his room at night, making it relatively easy to take control of allergens during that time.

Information is Key
When we observe children with respiratory disease living in squalor, we should at least provide their parents with information about the benefits of cleaning up the house. Providing families with information about environmental assessment and second-hand smoke is both free and easy. Flyers and pamphlets are available for free or for a minimal fee. The Environmental Protection Agency Web site features a one-page flyer called “Clearing the Air of Asthma Triggers” (http://www.epa. gov/iaq/ asthma/images/10_steps_en .pdf) that can be copied and included in the materials you already provide. And the American Lung Association has excellent materials specifically addressing second hand smoke. Call 800-LUNGUSA to connect with your nearest chapter.

Incorporating these materials into your pediatric home care routine is not difficult or time-consuming, but it can make a fundamental difference in helping families realize that asthma affects everyone in the home. Successful treatment requires educational reinforcement from everyone on the health care team, and participation of the entire family.

Community Involvement
One of the most rewarding aspects of providing respiratory home care is the opportunity to become involved in the community and help our patients connect with the resources that are available. Asthma education programs are springing up in communities across the country, and these programs depend on physician’s offices, community health clinics, and HME providers to refer appropriate patients to their services. These programs are often offered free of charge or for a minimal fee, as hospitals and third-party payors begin to analyze the cost associated with not providing asthma education to the people who need it the most.

Cindy Coopersmith, RRT, is a certified asthma educator and manages the “Taming the Tiger” asthma education program at a Colorado hospital. She says, “Every time you meet someone with asthma, it’s a teachable moment. If we are respiratory therapists involved in home care, we should not let these moments pass us by.”

If your community has an asthma education program, why not include promotional information about it with every setup involving an asthma diagnosis? If your community does not already have an asthma education program, there is an opportunity to work with respiratory departments and physicians in your community to create one.

The American Lung Association’s “Open Airways for Schools” program for children, ages 8 to 11, is an excellent place to start because the materials and format have already been created. Open Airways can provide an important service for children with asthma whose disease often goes undetected or undertreated.

Does your community have a summer camp program for children with asthma? These camps typically offer comprehensive asthma education to grade school and middle school children in a 1-week residential or day camp atmosphere. You can assist your patients and your community by helping recruit campers and volunteers. Many of the volunteers who staff these camps are asthma and allergy specialists, pulmonologists, and respiratory and nursing staff from hospitals and medical practices. HME providers can contribute important expertise and problem-solving skills. Clinical staff that have not worked in the home care environment are often at a disadvantage when trying to provide respiratory care in the field. They welcome the insight and solutions HME providers can provide. By volunteering for programs like asthma camp, you can make an important contribution, and distinguish yourself from the competition at the same time.

The American Association for Respiratory Care and the American Thoracic Society have become increasingly involved in the National Heart, Lung, and Blood Institute “Test Your Lungs—Know Your Numbers” drive, encouraging physician’s offices to provide basic spirometry screening for everyone. This is in response to the unfortunate fact that so much lung disease goes undetected until it reaches an advanced stage or an acute crisis. Community screening events require competent staff to perform the testing. Community health screens can specifically target children, adults, or both. HME providers can work with physicians’ offices and respiratory therapy departments to provide leadership in planning, promoting, and executing the events.

Providing our patients with access to important resources and encouraging them to get involved in managing their disease can make the difference between merely providing equipment and the satisfaction that comes with knowing we made a difference. And becoming involved in our health care community can have tangible payoffs as well. In time, we can stop seeing our clients as “referral sources,” and begin to know them as fellow associates. Before long, they will see each of us as a competent, committed professional rather than as just another “sales rep.” A demonstrated commitment to making a difference in the community can keep us connected and position ourselves as real leaders. The opportunity is knocking; we have only to open the door.

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John A. Wolfe, RRT, works at Poudre Valley Hospital in Fort Collins, Colo. He can be reached via email; johnalfredwolfe@comcast.net.