Ensuring Access to Albuterol in Schools: From Policy to Implementation. An Official ATS/AANMA/ALA/NASN Policy Statement

Abstract

Rationale: For children with asthma, access to quick-relief medications is critical to minimizing morbidity and mortality. An innovative and practical approach to ensure access at school is to maintain a supply of stock albuterol that can be used by any student who experiences respiratory distress. To make this possible, state laws allowing for stock albuterol are needed to improve medication access. Objectives: To provide policy recommendations and outline steps for passing and implementing stock albuterol laws. Methods: We assembled a diverse stakeholder group and reviewed guidelines, literature, statutes, regulations, and implementation documents related to school-based medication access. Stakeholders were divided into two groups—legislation and implementation—on the basis of expertise. Each group met virtually to review documents and draft recommendations. Recommendations were compiled and revised in iterative remote meetings with all stakeholders. Main Results: We offer several recommendations for crafting state legislation and facilitating program implementation. 1 ) Create a coalition of stakeholders to champion legislation and implement stock albuterol programs. The coalition should include school administrators, school nurses and health personnel, parents, or caregivers of children with asthma, pediatric primary care and subspecialty providers (e.g., pulmonologists/allergists), pharmacists, health department staff, and local/regional/national advocacy organizations. 2 ) Legislative components critical for effective implementation of stock albuterol programs include specifying that medication can be administered in good faith to any child in respiratory distress, establishing training requirements for school staff, providing immunity from civil liability for staff and prescribers, ensuring pharmacy laws allow prescriptions to be dispensed to schools, and suggesting inhalers with valved holding chambers/spacers for administration. 3 ) Select an experienced and committed legislator to sponsor legislation and guide revisions as needed during passage and implementation. This person should be from the majority party and serve on the legislature’s health or education committee. 4 ) Develop plans to disseminate legislation and regulations/policies to affected groups, including school administrators, school nurses, pharmacists, emergency responders, and primary/subspecialty clinicians. Periodically evaluate implementation effectiveness and need for adjustments. Conclusions: Stock albuterol in schools is a safe, practical, and potentially life-saving option for children with asthma, whether asthma is diagnosed or undiagnosed, who lack access to their personal quick-relief medication. Legislation is imperative for aiding in the adoption and implementation of school stock albuterol policies, and key policy inclus...

Asthma policy in Illinois: A survey of school nursing and staff knowledge and implementation patterns

“…of National School Nurse Workforce Study participants did (Volerman et al, 2021). Demographic information was not collected, so we cannot speak to the representativeness of our sample in terms of race, ethnicity, sex, or geographic location.…”

“…Our cross‐sectional study had some limitations. We had a low response rate (8%) and likely had a response bias‐ nurses serving only one school may have had more time to take the survey and therefore been overrepresented in our dataset, potentially explaining why only 32% of nurses in our survey served two or more schools, but 67.2% of National School Nurse Workforce Study participants did (Volerman et al., 2021). Demographic information was not collected, so we cannot speak to the representativeness of our sample in terms of race, ethnicity, sex, or geographic location.…”

“…According to the 2018 National School Nurse Workforce Study, 4.8% of schools in the midwestern region of the US have at least one Licensed Practice Nurse (LPN), 64.5% have at least one Registered Nurse (RN), and 6.9% have both. More than two thirds (67.2%) of Midwestern nurses work in two or more schools (Volerman et al, 2021). However, stock inhaler program uptake in Illinois has been slow, with only 11 districts reporting stock inhaler use over the 2021-2022 school year (Ayala, 2022).…”

Updates in school-based asthma management

“…Stock albuterol inhaler use in schools is safe and effective, ensuring that all children have access to their rescue medication while at school, with important recent scientific advances [41 ▪▪ ,42 ▪▪ ]. Stock albuterol use has been shown to avoid the need for escalated care such as summoning the emergency medical system and allows children to remain in school when experiencing asthma symptoms [41 ▪▪ ,43,44].…”

“…Approximately 18 U.S. states have passed legislation that allows schools to procure, stock and administer stock albuterol to students; however, these laws vary widely across states [45 ▪▪ ]. Expert organizations have created policy recommendations that guide states on lobbying for stock inhaler legislation and provides recommendations for program implementation on a state level [42 ▪▪ ]. Recently, stock inhaler events were examined among 228 schools located in Tucson, Arizona, and data suggested that not only were stock inhalers used by all schools across the socio-economic spectrum, but all children can benefit from having a stock inhaler at their school (with no adverse events reported) [46].…”