It is the position of the National Association of School Nurses to support students with asthma who actively participate in the self-management of their condition and in self-administration of prescribed, inhaled, quick relief bronchodilator asthma medications (rescue inhalers).
The decision to allow a student to carry and self-administer rescue inhalers should be made in adherence to state laws and policies related to permitting students to carry and self-administer medication. Written permission from the parent must be accompanied by documentation from the health care provider confirming that the student has the knowledge and skill to safely possess and competently self-administer a rescue inhaler. In the school setting, the school nurse is the most appropriate professional to assess the student’s ability to demonstrate competency in carrying and using the medication safely and appropriately.
The prevalence of asthma is 7.1 million or 9.6% of children under 17 years of age in the United States (Bloom, Cohen & Freeman, 2010).
Asthma can be a life-threatening disease if not properly managed. While deaths due to asthma are rare among children, the number of deaths increases with age. In 2006, 131 children under 15 died from asthma compared to 653 adults over 85 (Heron et al., 2009)
Asthma is the third leading cause of hospitalization among children under the age of 15 (DeFrances, Cullen & Kozak, 2007). Approximately 32.7 percent of all asthma hospital discharges in 2006 were in those under 15; however, only 20.1% of the U.S. population was less than 15 years old (ALA, 2010a).
Asthma is one of the leading causes of school absenteeism (NCCDPHP, 2009).
In 2008, asthma accounted for an estimated 14.4 million lost school days in children with an asthma attack or episode in the previous year (ALA, 2010a).
Rescue inhalers are emergency medications and must be dispensed quickly to effectively treat asthma symptoms. Legislation that protects a student’s right to carry and self-administer asthma medications in schools is now in effect in all 50 states (ALA, 2010b). Most of the laws regarding self-administration of inhalers do not distinguish between the kindergarten and 12th-grade student. Elementary children, especially those under 7 years of age, should be supervised with their inhaled medications (Flower & Saewyc, 2005). Determination of whether a student may safely carry and self-administer a rescue inhaler should consider the child’s age and developmental level, his or her ability to demonstrate competency in using the medication safely and appropriately, the recommendations of the parent and health care provider, and the availability of a school nurse.
Students who carry and self-administer their inhalers properly can prevent or reduce the severity of their asthma episodes (Moore, Uyeda, Cuevas, & Villanueva, 2010). In addition, self-administration of rescue inhalers using proper inhalation technique can be a very important step in a student’s overall asthma management.
The decision to allow student self-administration of a rescue inhaler is best determined by (1) overall supervision by the professional school nurse with appropriate, periodic nursing evaluation of the student’s technique and self-assessment skills, and supervision of any delegatory functions that may apply to unlicensed assistive personnel, (2) the consent of the parent/guardian, and (3) collaboration with the prescribing provider who should also be confirming the student’s ability to safely and appropriately use his or her rescue inhaler as outlined in the student's asthma action plan.
For the majority of children with asthma, proper monitoring and management ensures that the child is able to participate in normal, everyday activities. Rescue inhalers are prescribed medications that act rapidly upon the airway to treat acute asthma symptoms. Timely and rapid administration of the rescue inhaler is crucial for a student with asthma. Because children spend a good portion of their day in the school setting, students must have appropriate access to rescue medication to control asthma at school. Students who carry inhalers may not always have one when needed, so it is important to keep a personal back-up inhaler in the health office.
School district medication policies and procedures must be developed to provide the best quality of care for students with asthma while at the same time ensuring the safety of all students. School district medication policies/procedures should include criteria for the safe and appropriate implementation of self-administration of asthma rescue inhalers.
THE ROLE OF THE SCHOOL NURSE
The registered nurse in the school plays a vital role in developing and implementing asthma action plans, assessing students’ ability to safely self-manage their asthma, and monitoring individual student’s level of asthma control. The school nurse provides ongoing education to students on proper inhalation technique and recognition of symptoms that require urgent intervention, provides asthma education to school staff as well as identifies when a student's rescue inhaler is not effective and requires Emergency Medical Services (EMS).
American Lung Association (ALA). (2010a). Asthma and children fact sheet. Retrieved from http://www.lungusa.org/lung-disease/asthma/resources/facts-and-figures/asthma-children-fact-sheet.html
American Lung Association ( ALA). (2010b). Can my child carry an inhaler at school? Retrieved from http://www.lungusa.org/lung-disease/asthma/in-schools/for-parents/can-my-child-carry-an-inhaler.html
Bloom B., Cohen R. A. &Freeman, G. (2010). Summary health statistics for U.S. children: National Health Interview Survey, 2009. National Center for Health Statistics. Vital Health Statistics, 10(247), 1-91. Retrieved from http://www.cdc.gov/nchs/data/series/sr_10/sr10_247.pdf
DeFrances, C. J., Cullen, K. A., & Kozak L. J. (2007). National Hospital Discharge Survey: 2005 annual summary with detailed diagnosis and procedure data. National Center for Health Statistics. Vital Health Statistics, 13 (165), 1 - 209. Retrieved from http://www.cdc.gov/nchs/data/series/sr_13/sr13_165.pdf
Flower, J. & Saewyc, E. M. (2005). Assessing the capability of school-age children with asthma to safely self-carry an inhaler. Journal of School Nursing, 25, 283-292. doi: 10.1177/10598405050210050701
Heron, M., Hoyert, D. L., Murphy, S. L., Xu, J., Kochanek, K. G. & Tejada-Vera, B. (2009). Deaths: Final data for 2006, National Vital Statistics Report, 57(14), 1 - 135.
Moore, C., Uyeda, K., Cuevas, Y., & Villanueva. R. (2010). Los Angeles Unified School District’s comprehensive asthma program: Results show decreased asthma symptoms and missed school days among students with asthma. NASN School Nurse, 25, 210-212. doi:10.1177/1942602X10374344
National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). (2009). Healthy youth! Asthma. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. Retrieved from http://www.cdc.gov/HealthyYouth/asthma
Acknowledgement of Authors:
Patty Mancuso, BSN, RN
Susan Hoffmann, MSN, RN, NCSN
Joanne Blout, ADN, RN, NCSN
Adopted: June 2011
This document replaces the following Position Statement:
Asthma Rescue Inhalers in the School Setting, The Use of (Adopted: 1993; Revised: 1999, 2005)