School Inhaler Program a Success
Arizona is a pioneer and national example for implementing an evidence-based rescue medication school-based program, the Stock Inhalers for Schools Program. Statewide, there are approximately 475 charter, private/parochial and public schools participating the 2022-2023 academic year including: (250) schools in Pima County, (206) in Maricopa, (6) in Yavapai, Pinal and Cochise Counties, respectively.
Asthma prevalence among U.S. children is about 8.6%. In AZ, severe respiratory distress leads to lost school time and approximately 2,700 9-1-1 calls every year. About 50% of these calls result in EMS transports to the emergency department (ED) but many of these ED admissions can be prevented.
A 2-year pilot Stock Inhaler Program in Tucson showed a 20% reduction in asthma-related 9-1-1 calls and a 40% reduction in asthma-related emergency transports. The program director, Professor Lynn Gerald of the University of Arizona, spearheaded passage of legislation in 2017, H.B. 2208, “Stock Inhalers for Schools,” that allows schools across Arizona to implement this program.
The program costs about $100 - $150 per school for the medication and valved holding chambers. A template step-by-step guide and toolkit are featured on our website at: azasthma.org/take-action.
Pima County started the program in 229 schools in the 2017-18 school year. During that time inhalers were used 1,038 times. Of these events, students returned to class in 84% of the cases. Overall, (6) 9-1-1 calls occurred to EMS, and 5 events resulted in the student being transported via EMS.
More recently, the Maricopa County Department of Public Health launched the stock albuterol inhaler program in 2018-19. Schools in this county can enroll and follow an electronic step-by-step guide at this site: https://ssmp.maricopa.gov. For assistance or questions, contact PublicHealthNurse@Maricopa.gov.
Other states are inquiring about how to set up programs after reading journal articles submitted by Drs. Lynn Gerald and Ashley A. Lowe. ("Guidelines for the administration of medication in school. Committee on School Health," 2003; Lowe, Gerald, et al., 2022; Lowe et al., 2021; Lowe, Phan, et al., 2022; Volerman et al., 2021)
Our goal is to expand the program to all schools statewide.
We invite you to join us stakeholder Zoom calls at noon on the 2nd Monday of each month where we share information about the program and help each other. To join, contact Lisa Rascon, M.Ed. at lrascon@arizona.edu.
Primary Contact for the Arizona Stock Inhaler Program:
Ashley A. Lowe, PhD, MSPH
University of Arizona
aaray@arizona.edu
Guidelines for the administration of medication in school. Committee on School Health. (2003). Pediatrics, 112(3 Pt 1), 697-699.
Lowe, A. A., Gerald, J. K., Clemens, C., & Gerald, L. B. (2022). School-based Stock Inhaler Programs and Neighborhood Disadvantage. J Health Care Poor Underserved, 33(2), 1083-1093. https://doi.org/10.1353/hpu.2022.0082
Lowe, A. A., Gerald, J. K., Clemens, C. J., Stern, D. A., & Gerald, L. B. (2021). Managing respiratory emergencies at school: A county-wide stock inhaler program. J Allergy Clin Immunol, 148(2), 420-427.e425. https://doi.org/10.1016/j.jaci.2021.01.028
Lowe, A. A., Phan, H., Hall-Lipsy, E., O'Shaughnessy, S., Nash, B., Volerman, A., & Gerald, L. B. (2022). School Stock Inhaler Statutes and Regulations in the United States: A Systematic Review. J Sch Health, 92(4), 396-405. https://doi.org/10.1111/josh.13142
Volerman, A., Lowe, A. A., Pappalardo, A. A., Anderson, C. M. C., Blake, K. V., Bryant-Stephens, T., Carr, T., Carter, H., Cicutto, L., Gerald, J. K., Miller, T., Moore, N. S., Phan, H., Sadreameli, S. C., Tanner, A., Winders, T. A., & Gerald, L. B. (2021). Ensuring Access to Albuterol in Schools: From Policy to Implementation. An Official ATS/AANMA/ALA/NASN Policy Statement. Am J Respir Crit Care Med, 204(5), 508-522. https://doi.org/10.1164/rccm.202106-1550ST
