Concerns About Stock Albuterol for Asthma in Illinois Schools Are Overstated, Researchers Say

A new study shows that even in states with strong stock inhaler/albuterol laws, school administrators and prescribing clinicians fear liability in prescribing and administering the inhalers. The findings were presented at this year’s American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting in Louisville, Kentucky.

Stock inhaler laws, which exist in 18 states, are meant to address the issue of children who come to school without their asthma inhalers, do not possesses inhalers, or do not know they have asthma. Asthma is one of the most common pediatric respiratory conditions and disproportionately affects Black and Latinx children. Stock albuterol can be used by any child experiencing respiratory distress in school.

The study presented at the ACAAI meeting looked at schools in Illinois, which has had a stock albuterol law in place since 2019. The researchers conducted 20 key stakeholder interviews with nurses, clinicians, and school administrators and found that 35% of those interviewed cited difficulty obtaining prescriptions for stock inhalers as a barrier to implementation.

Liability concerns were one reason for the inability to procure prescriptions.

However, a recent systematic review of liability verbiage of stock inhaler laws show that Illinois’ wording is strong, making liability extremely unlikely, the authors said. The law reads that schools, districts, employees, agents, and prescribers “are to incur no liability or professional discipline, except for willful and wanton conduct, as a result of any injury arising from the use of…undesignated asthma medication.”

The study also looked at factors that would make stock inhaler laws easier to implement. The factors include finding a provider to write a prescription, local "champions" to push for implementation, and funding from the state or school district having funding.

“Having an asthma reliever inhaler, such as albuterol, available to any child who might be experiencing respiratory distress is vital to addressing asthma symptoms and/or emergencies that may happen during the school day,” allergist Andrea A. Pappalardo, MD, ACAAI member and lead author of the study, said in a statement. "We wanted to examine the barriers and facilitators to stock inhaler programs in schools in Illinois and throughout states with similar legislation to better understand how we can improve medication access throughout our state, and nationwide.”

“Even though Illinois has strong wording to protect prescribers of stock inhalers and those who administer stock inhalers, prescribers are still cautious of providing a prescription for stock inhalers and related supplies to school districts. Without a prescription, stock inhalers cannot be implemented in schools. Enhanced education and the verbiage related to liability will alleviate these concerns and improve uptake of stock inhalers in Illinois, and other states,” she said.

“Stock inhaler programs provide critical reliever inhaler access in schools where children spend most of their day. Children and staff can benefit from having a stock inhaler available when an inhaler is not present at the school for that individual due to lack of diagnosis, forgetting it at home, or inability to obtain an inhaler for a multitude of access-related issues. Having potentially life-saving medications for asthma emergencies and daily symptoms alike is critical to keeping our children in class where they belong.”

Reference

Pappalardo AA, Wrona J, Hardy P, Schwartz A, Cambell A. Liability: a misunderstood barrier to stock albuterol implementation in Illinois schools. Presented at: ACAAI 2022 Annual Scientific Meeting; November 10-14, 2022; Louisville, KY. Abstract P094.