Emergency Use of Stock Albuterol for the Student with Known Asthma in the School Setting
It is the position of the National Association of School Nurses (NASN) that schools should stock albuterol for emergency use by the registered professional school nurse (hereinafter referred to as school nurse) for students with known asthma who exhibit symptoms of respiratory distress as specified in standing orders or protocol. To optimize student health, safety and learning, a school nurse should be present in every school, all day, every day to assure appropriate and accurate assessment and timely treatment. Although students perform better academically and are more likely to succeed in school when they are consistent in attendance and physically present in class, , 49% of students with asthma report missing one or more asthma-related days per school year (Centers for Disease Control and Prevention [CDC], 2015). Additionally, research shows that over 60% of asthma deaths in children are the result of a sudden asthma attack that can be fatal within an hour (American Lung Association, 2014). It is recommended that students with asthma begin treatment at the first sign of coughing, wheezing, shortness of breath and/or complaint of chest tightness to decrease the risk of possible hospitalization and to preserve life (Allergy and Asthma Network, 2016).
To enhance student safety, NASN recommends that schools should:
● Assure that school nurses are available in every school, all day, every day so that students who have symptoms of serious health problems have access to nursing assessment and treatment as soon as possible.
● Develop policies for the emergency management of students’ symptoms of coughing, wheezing, shortness of breath and/or complaint of chest tightness which may require treatment with albuterol.
● Ensure that albuterol policies are developed within the context of applicable state and national legislation, regulations, guidelines, and provider orders to protect the health and safety of students.
● Provide albuterol for use by the school nurse for students with known history of asthma who exhibit symptoms of coughing, wheezing, shortness of breath and/or complaint of chest tightness.
NASN recommends that school nurses should:
● Identify and assess students at risk for underlying chronic health conditions such as asthma which may lead to coughing, wheezing, shortness of breath and/or complaint of chest tightness requiring treatment with albuterol.
● Collaborate with parents, students and healthcare providers to develop Individualized Healthcare Plans, Asthma Action Plans, and/ or Emergency Care Plans to address the needs of students with asthma.
● Administer albuterol according to standing orders and protocols when students experience coughing, wheezing, shortness of breath and/or complaint of chest tightness.
● Educate unlicensed assistive personnel, teachers, and other staff about signs of respiratory problems for which a school nurse should be immediately notified.
● Re-assess, document and notify parents or guardian about response to treatment.
Asthma is the leading chronic disease in children (CDC, 2018). Approximately 10% of children in the United States have asthma and about 60% of these students experience an exacerbation of their asthma each year (Gerald et al., 2016). School-age students missed 13.8 million days of school in 2013 alone due to asthma-related concerns (CDC, 2015). According to research conducted by Ginsburg, Jordan & Chang (2014), students who miss more school than their peers have consistently lower scores on standardized testing. Additional research has found an association between asthma with increased absences and decreased academic achievement (Michael, Merlo, Basch, Wentzel, & Wechsler, 2015). With the administration of stock albuterol at school, more students could safely remain in school and decrease missed class time. In addition, the availability of stock albuterol in the school setting addresses Healthy People 2020 objectives related to the reduction of the adverse effects due to asthma for school-age children (U. S. Department of Health and Human Services, Office of Disease Promotion and Health Promotion, 2017).
Albuterol can be a life-saving medication in treating students who experience coughing, wheezing, shortness of breath and/or complaint of chest tightness. NASN supports school policies which promote access to albuterol. NASN believes it is critical for states and school districts to develop policies which allow and promote stock albuterol in the school setting and which permit access and administration of albuterol by school nurses in order to protect the safety of students and keep them in school, healthy, safe and ready to learn.
Allergy and Asthma Network. (2016). Bronchodilators. Retrieved from http://www.allergyasthmanetwork.org/education/asthma/treatment-and-medications/bronchodilators/
American Lung Association. (2014). Improving Access to Asthma Medications in Schools: Laws, Policies, Practice and Recommendations. Retrieved from http://www.lung.org/assets/documents/asthma/improving-access-to-asthma.pdf
Centers for Disease Control and Prevention. (2015). Asthma-related missed school days among children 5-17 years. Retrieved from https://www.cdc.gov/asthma/asthma_stats/missing_days.htm
Centers for Disease Control and Prevention. (2018). Managing asthma in schools. Retrieved from https://www.cdc.gov/healthyschools/asthma
Gerald, L.B., Disney, J., Gerald, J. K., Thomas, A., Wilcox, G., & Brown, M.A. (2016). Implementation and evaluation of a stock albuterol program for students with asthma. Annals of the American Thoracic Society, 13(2), 295-296. Retrieved from http://www.atsjournals.org/doi/pdf/10.1513/AnnalsATS.201510-683LE
Ginsburg, A. J., Jordan, P., & Chang, H. (2014). Absences add up: How school attendance influences student success. Retrieved from http://www.attendanceworks.org/wp-content/uploads/2017/05/Absenses-Add-Up_September-3rd-2014.pdf
Michael, S., Merlo, C., Basch, C., Wentzel, K., & Wechsler, H. (2015). Critical connections: Health and academics. Journal of School Health. 85(11). P. 740-758.
U.S. Department of Health and Human Services, Office of Disease Promotion and Health Promotion. (2017). Healthy People 2020: Respiratory diseases. 2020 topics and objectives. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/respiratory-diseases/objectives
Acknowledgement of Authors:
Valerie Beshears, MSN, RN, NCSN
Elaine Mauter, BSN, RN
Annette Johansen, M.Ed., BSN, RN, NCSN
Lindsey Minchella, MSN, RN, NCSN, FNASN
Tina Miller, BSN, RN
Cynthia Less, MSN, RN, NCSN
Janet Thornton, MSN, ED., BSN, RN
Christine Amidon, BSN, RN, NCSN
Adopted: August 2017
Revised: August 2018
Renewed: April 2019
Suggested Citation: National Association of School Nurses. (2018). Emergency use of stock albuterol in the school setting (Position Brief). Silver Spring, MD: Author.
All position briefs from the National Association of School Nurses will automatically expire 18 months after publication unless renewed and recommended for position statement or other NASN document development.