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School Inhaler Program

A new state law in 2017 and related Arizona State Board of Education regulation now make it possible for public, charter and private schools to administer emergency Albuterol inhalers if a student or adult experiences respiratory distress.

Asthma prevalence among children is about 10%.  In Arizona, severe respiratory distress among children 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.

A 2-year pilot program for stock inhalers at schools in Tucson demonstrated a 20% reduction in 911 calls and a 40% reduction in emergency transports.  The program designer, Professor Lynn Gerald, PhD, MSPH, of the University of Arizona Asthma & Airway Disease Research Center, spearheaded passage of a law that allows schools in Arizona to implement this program. 1

Pima County, which includes the Tucson metropolitan area, implemented the inhaler program in 230 schools in the 2017-18 school year. Outcomes:

  • Schools documented 1,026 stock inhaler uses 
  • 82.4% of uses had a previously known asthma diagnosis
  • 5 calls to 9-1-1 with EMS transport (0.5%)
  • 1 call to 9-1-1 with no EMS transport (0.1%)
  • 773 kids returned to class (83.9%)
  • 142 returned home with caregiver (15.4%)
  • The program costs about $100 per school for Albuterol and spacers 

Based on Medicaid reimbursement rates for EMS transport and ED admission, the estimated cost savings per year in Pima County: $130,000. If the program becomes statewide, cost savings would be an estimated $900,000 per year.

Pima County Sponsors for the first year included the Mel and Enid Zuckerman College of Public Health, Banner University Medical Center-Tucson with its donation of Albuterol medication, and Thayer Medical Corporation, which donated spacers. Ongoing sponsors include Mel and Enid Zuckerman, Banner University Medical Center-Tucson and Thayer Medical Corporation.

Maricopa County Department of Public Health launched the school inhaler program in the Phoenix metropolitan area in 2018-19. 70 schools have signed up to participate starting in August. Funding for the first year supply of medication is being provided by the county and Banner Foundation. Schools in this county can enroll and follow a step-by-step guide at this site: https://ssmp.maricopa.gov/. For assistance or questions, contact PublicHealthNurse@Maricopa.gov.

Prescott Unified School District will offer the program beginning in the 2019-20 school year and Dr. Gerald is working with the Navajo Nation to provide it for several tribal school districts, with the participation of the Indian Health Service.

Program Components:

The inhaler regulation, pursuant to Regulation ARS 15-158, includes the following provisions:

  • School districts that elect to administer inhalers shall develop inhaler policies and procedures in compliance with the regulations
  • At least two designated employees per school must complete annual online training to recognize the symptoms of respiratory distress and how to render emergency treatment; the proper storage of medications; and emergency follow-up procedures.
  • Participating schools are required to have a standing order for use of the medication from a school or public health Medical Director, licensed physician or nurse practitioner
  • The trained staff members shall be responsible for
    • Acquiring the medication and inhalers
    • Storing and managing the medication properly
    • Administering the medication to students or adults who exhibit signs of respiratory distress while at school or a school-sponsored event
    • Contacting the parent or guardian regarding the incident
    • Contacting 9-1-1 if necessary
    • Documenting and retaining the incident data
  • Schools may accept funding or grants to purchase inhalers and spacers
  • Medical providers who sign standing orders, the school district and employees of participating schools are immune from legal liability

Supplies Needed:

Most schools begin with one 60-dose Albuterol inhaler and 5 spacers.

Spacers make it easier for medication to reach the lungs, and also mean less medication gets deposited in the mouth and throat. For example, this is a paperboard design that stores flat and pops up for use.

The inhaler can be used for multiple people as long as each person uses a different spacer. Schools with more than 800 students might need additional supplies during the year, depending on how often the medication is used.

Cost of the Program:

The supplies cost up to $100 per school for one unit of Albuterol and 5 spacers. Many schools find the funding in their budget for health services. For schools without funds for start-up, donations may be available from parent-teacher groups, local boosters, hospitals, the county public health department, health providers or parents.

How to Get Started:

All the resources for starting the program are available by clicking the menu items at the left.

Questions specific to the implementation may be sent to Ashley Lowe via email at Stockinhaler@email.arizona.edu.

1. LB Gerald, J Disney, J Gerald, A Thomas, G Wilcox, MA Brown. Implementation and Evaluation of a Stock Albuterol Program for Students with Asthma. Annals ATS Volume 13 Number 2, February 2016

About the Coalition

As a nonprofit partnership since 1996, AAC has worked together with concerned stakeholders including public health, environmental quality, managed care, education, individual physicians and nurses, hospitals, foundations, families and other colleagues.



Arizona Asthma Coalition

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