Children with Duchenne muscular dystrophy (DMD) who do not follow their prescribed lung volume recruitment (LVR) therapy plan initially are unlikely to become adherent over time, according to findings recently published in Pediatric Pulmonology.
LVR therapy is a respiratory care technique where a patient takes multiple small breaths while a handheld bag or ventilator is used to expand the lungs. This helps patients with weakened respiratory muscles to cough, which can clear the airways and prevent infection. It can also help slow pulmonary decline.
Findings were based on the STEADFAST trial, which randomized a group of boys aged 6 to 16 years with DMD to receive either LVR therapy twice per day for two years or the standard of care. Every three months, the investigators analyzed data from the LVR equipment to ascertain the number of uses within the treatment group. Participants also provided self-reports on comfort and satisfaction with the technique.
The researchers defined adherence as performing LVR therapy at least once per day for more than half of the days of the study period. Based on this definition, only 42.4% of participants randomized to receive LVR therapy were adherent.
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Furthermore, of the participants who did not adhere within the first three months of the study, only one individual became adherent by the end of the study period. Those who were initially adherent remained so throughout the study.
Most of the baseline characteristics between the adherent and non-adherent groups were similar. However, the adherent group did have a significantly lower forced vital capacity at baseline, indicating poorer lung function. These individuals might view LVR as more beneficial than those with greater lung function, the researchers surmised.
Long-term adherence to LVR therapy was not associated with changes in lung function over time, quality of life or symptoms, however.
Interestingly, the investigators found that very few participants in both the adherent and non-adherent groups reported feeling uncomfortable with LVR therapy. Only two adherent individuals and three non-adherent individuals were unsatisfied with the treatment. This indicates that the non-adherent group may have other, unexplored reasons for not utilizing the therapy.
“These findings underscore the importance of early support and education to promote long-term LVR adherence,” the authors concluded. “Health care practitioner support, particularly at the onset of therapy, may be useful to ensure that children and families are comfortable in using LVR and educated about its intended benefits.”
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