Andrea A. Pappalardo, MD

Asthma in children is common and has potentially life-threatening implications. Asthma requires emergency or reliever medications in the event of asthma symptoms; the most common of these medications is albuterol (an inhaler). It is imperative that albuterol is available to school-aged children while in school and that the staff know when and how to administer it. Children with asthma or those with undiagnosed asthma frequently do not have albuterol at school. Having stock, or undesignated, albuterol in schools is a potential solution for children who are experiencing asthma symptoms, but do not have access to their own albuterol inhaler at school. A law that allows for stock albuterol to be available to children and staff in Illinois schools was passed in 2018, but few Illinois schools have implemented it due to several barriers. Our project uses an implementation science-based strategy to determine elements that will support successful stock albuterol availability in Illinois schools. We are proactively addressing barriers and expanding the number of schools throughout Illinois that allow for potentially life-saving albuterol access. To gain the diverse insight needed to appropriately build undesignated medication stocking programs, we interviewed and surveyed national/state organizations and school representatives from urban, rural, and suburban districts in Illinois and other states. Based on initial interviews and surveys, we know that most school health stakeholders approve of stock albuterol. Facilitators of implementing successful programs include appropriate funding and staffing, connections to healthcare providers who prescribe albuterol, and awareness/knowledge of the legislation. Barriers include insufficient personnel, pharmacy willingness to fill orders, funding, training, and reporting difficulties. We are already working on overcoming barriers by collaboratively finding solutions such as funding, ongoing education to diverse statewide stakeholders and clinical and non-clinical school staff and facilitating medication and prescription access. These actions should support success of the program for the entire state. Using these data, we will pilot a stock albuterol implementation model that can be disseminated and adapted for states considering legislation and/or implementation of stock albuterol legislation. Schools have already committed to and are preparing for our collaborative stock albuterol implementation pilot in the 2022-2023 school year. Committed schools come from across Illinois and represent urban, suburban and rural districts that are all in counties that were identified by the Illinois Department of Public Health as having a high asthma burden. With our work, we have built a network of stakeholders both statewide and nationally that influences school health on a larger scale. Our goal is to support stock inhaler policy and implementation in states and stakeholders across the nation of this school-based asthma program that has the capacity to greatly influence child health, and to reduce health disparities.

Update: When a child has an asthma attack, one of the medications that can help is called albuterol. Children do not always have access to an albuterol inhaler at school, placing them at risk. Illinois passed a law that allows albuterol to be kept at schools for any child with asthma symptoms; but many schools don’t have it yet. Based on our initial research, we know schools approve of stock albuterol, but have encountered several barriers to obtaining it. We are collaboratively finding solutions that allow for schools across Illinois to have albuterol and sustain a potentially life-saving program.