Assessing the Capability of School-Age Children With Asthma to Safely Self-Carry an Inhaler

Abstract

The purpose of this descriptive study was to pilot test an Asthma Assessment Interview (AAI) and to determine the approximate age a child with asthma is capable to self-carry an inhaler. A random sample of 34 students with asthma (Grades K through 10) from a midwestern school district were interviewed by the school nurse using the AAI, which assesses knowledge of asthma, symptoms, coping strategies, medication administration skills, triggers, and judgment about when to use an inhaler including the ability to tell time. Only 38% passed the AAI. No students ages 5 to 7 passed, fewer than 50% of students ages 8 to 10 passed, and half or more of students age 11 or older passed the AAI. Results suggest a school nurse should supervise elementary students when using an inhaler; most should not self-carry. The AAI can be a useful part of the school nurse's assessment.

Potential Life-Threatening Events in Schools Involving Rescue Inhalers, Epinephrine Autoinjectors, and Glucagon Delivery Devices: Reports From School Nurses

“…Finally, one study seeking to determine at what age (or grade) an asthmatic child is capable of safely self-carrying his or her own inhaler had found that only 13 (38%) of the 34 student participants passed the assessment. The mean passing age was 12 years old and the mean passing grade was 6.54 (Flower & Saewyc, 2005).…”

Prediction of asthma exacerbations among children through integrating air pollution, upper atmosphere, and school health surveillances

“…19 Studies found that self-carry of asthma medications should be based on a student's ability and self-efficacy in selfadministering the medication rather than on the severity of asthma symptoms. 20 According to Pennsylvania State regulations, each school entity (e.g., school district) must have a written policy to allow for the possession and self-administration by school-age children of an asthma inhaler and the prescribed medication to be administered in a school setting. 21 Because of these regulations that rely on developmentally appropriate restrictions, self-administration of asthma medication, while allowed on an individual basis at any age, is less likely to occur among elementary school students.…”

Upper-Air Observation Indicators Predict Outbreaks of Asthma Exacerbations among Elementary School Children: Integration of Daily Environmental and School Health Surveillance Systems in Pennsylvania

“…Self-carry of asthma medications should be based on a student's ability and self-efficacy in self-administering the medication rather than on the severity of asthma symptoms (15), and according to Pennsylvania state regulations, each school entity (e.g., school district) must have a written policy to allow for the possession and self-administration by school-age children of an asthma inhaler and the prescribed medication to be administered in a school setting (16). This policy shall require a child of school age that desires to possess and self-administer an asthma inhaler in a school setting to demonstrate the capability for selfadministration and for responsible behavior in the use of an asthma inhaler.…”

“…A written request is also required from the parent or guardian to the effect that the school entity complies with the order of the physician, certified registered nurse practitioner, or physician assistant." (16) Because of these regulations that rely on developmentally appropriate restrictions and the general consensus that a school nurse should supervise elementary students (15), self-administration of asthma medication, while allowable, is much less likely among elementary school students. Conversely, middle school and high school students are more likely to meet a developmentalreadiness standard and self-administer medication as 466…”

“…This massive burden may be a result of greater exposure to air pollutants (7)(8)(9)(10)(11) and increased influence of other risk factors, such as infections (12), pollen (13)(14)(15), and obesity (16) or improved care. In Pennsylvania, predictors of frequent asthma exacerbations were found to be (a) having Medicaid or Medical Assistance indicative of poverty, (b) lower level of education, (c) higher number of previous office or clinic visits, (d) greater number of household members, and (e) living in Philadelphia (17).…”