Stocking albuterol inhalers at schools could improve emergency asthma management

By Will Boggs

NEW YORK (Reuters Health) - 4/6/2019

Pediatricians should advocate for stocking albuterol inhalers at schools as a means of improving the management of asthma emergencies.

"Although we often prescribe albuterol, we may not realize that many children are left without an albuterol inhaler in school," said Dr. Andrea A. Pappalardo of the University of Illinois at Chicago.

"This leaves many children at risk for a possibly life-threatening asthma exacerbation with no immediate medication on hand to provide a solution. With nursing shortages and other challenges to asthma management in schools throughout the nation, it is imperative that we, as pediatricians, take an active role in keeping children with asthma safe where they spend a majority of their days," she told Reuters Health by email.

Dr. Pappalardo and Dr. Lynn B. Gerald of the University of Arizona in Tucson summarize the reasons they advocate stock inhaler policies at school in a report online June 4 in Pediatrics.

An estimated 38 asthma-related deaths occurred in the school setting between 1990 and 2003, 31% of them while awaiting medical intervention. Such events could be avoidable with stock albuterol inhalers, because access to rescue medications is a key component of guideline-based responses in asthma emergencies.

Currently, all 50 states permit children with asthma to self-carry personal inhalers, the authors note, but only 12 states have adopted stock-albuterol policies. They did so by amending their stock-epinephrine laws to include albuterol; amending an active policy or legislation is often easier than creating a new one.

Existing stock-inhaler policies mostly allow any trained personnel to administer the drug, but few policies include a clause that waives liability. The authors see the lack of such waivers as a major barrier to implementation and strongly advocate inclusion of waivers of liability.

Other important elements for future legislation should include the ability of chaperones and volunteers (not just employees or nurses) to administer inhalers, the ability of inhaler prescriptions to be written and dispensed to schools, and open wording such as "general respiratory distress" so that children without a known diagnosis of asthma may also benefit.

Implementation of stock-albuterol programs was associated with a 20% reduction in emergency calls and 40% fewer emergency-medical-services transports in one Arizona school district and with 84.5% of children administered albuterol through a stock-albuterol program in Missouri returning to class.

"The main barriers include concerns for who will be responsible for administration of stock albuterol when there is such a nursing shortage in schools," Dr. Pappalardo said. "Specifically, how we can ensure that an individual is trained to recognize the signs and symptoms of an asthma attack and know how to administer albuterol properly?"

"Another barrier is liability, which is why we recommend that any stock albuterol policy consider including a clause that waives liability to those who administer albuterol," she said. "One other barrier is rallying advocacy groups in one's state and identifying a pediatrician(s) champion to help impact this potentially lifesaving legislation."

"Advocating for simple policy solutions, like stock albuterol, can maximize our potential impact in our communities," Dr. Pappalardo said.


Pediatrics 2019.

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