School stock inhaler program
Published: February 10, 2021
Because children spend much of their time at school and approximately 10% of school children have asthma, having access to a rescue inhaler is important. Unfortunately, few children have access to a personal inhaler while at school. Stock inhalers, a single albuterol inhaler used with a disposable, valved-holding chamber give schools another option to respond to respiratory emergencies. Determining whether such programs are feasible across a wide range of schools is an important public health goal because stock inhaler use may prevent children from being sent home for an otherwise treatable asthma attack.
In a recent issue of The Journal of Allergy and Clinical Immunology (JACI), Lowe et al. examined the implementation of stock inhaler programs in charter, private, parochial and public schools in Pima County, Arizona. Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance), the authors systematically evaluated program implementation. Participating schools received a 60-dose short-acting beta-agonist (albuterol) stock inhaler, a supply of disposable valved-holding chambers, standardized treatment protocols, and a standing medical order for medication administration. Two school health personnel were required to complete an online training program before schools were able to participate. Any student with respiratory distress consistent with asthma were able to use a stock inhaler. Stock inhaler use documentation was collected at the end of the school year.
During the 2017-2018 school year, 229 schools enrolled in the program reaching 82% of the county’s school students. Sixty-six percent of schools (n=152) reported using a stock inhaler to manage 1,038 events. Seventy-nine percent of events occurred in students who had previously known asthma and 84% of events resulted in the student returning to class instead of being sent home. Only 6 events resulted in a 9-1-1 call and/or ambulance transport. Middle schools were 2.1 (95% CI 1.29 - 3.30) times more likely to use a stock inhaler than elementary schools and while private and parochial schools were 0.39 (95% CI 0.16-1.00) time less likely to use a stock inhaler as public schools.
Lowe et al. found that stock inhaler program implementation is feasible among diverse school organizational types (e.g., public or private) and can be safely implemented by schools serving students of any grade-level. Stock inhaler programs may have important public health benefits because most students are able to return to class instead of being sent home, or even worse, sent for urgent medical care. Additional policy efforts are needed to expand access to stock inhalers for students while they are at school. Currently, 13 states and the District of Columbia have legislation that enables schools to maintain stock inhalers and indemnifies trained school health personnel that use them in good faith.
*This study was conducted prior to the COVID-19 pandemic. When schools re-open, stock inhalers will continue to provide important benefits to children experiencing respiratory distress. Because inhaler administration is not aerosolizing, no additional mitigation measures are required beyond those recommended for low-risk patient encounters. When using a stock inhaler with a disposable or reusable one-way valved holding chamber, canisters should be cleaned between uses following the surface cleaning recommendations outlined by the Centers for Disease Control and Prevention (CDC).
The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.
Full Article
Graphical Abstract