June 11, 2019
3 min read

Q&A: Why pediatricians should advocate for stock inhalers in schools

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Photo of Andrea Pappalardo
Andrea A. Pappalardo

All children attending school in the United States are permitted to carry albuterol inhalers if they have been prescribed one by a physician. However, few children — approximately 14% — have access to emergency inhalers, according to research published in Pediatric Allergy, Immunology and Pulmonology.

Andrea A. Pappalardo, MD, an assistant professor of medicine and pediatrics at the University of Illinois at Chicago and a board-certified specialist in allergy and immunology, internal medicine and pediatrics, told Infectious Diseases in Children that 12 states currently have legislation that allows stock inhaler use in schools. These policies, she said, were introduced after these states implemented stock epinephrine policies.

Pappalardo and Lynn B. Gerald, PhD, MSPH, recently wrote an editorial published in Pediatrics that examines why pediatricians should be advocating for stock inhaler policies in schools.

Infectious Diseases in Children spoke with Pappalardo about the benefits of such policies in schools and how pediatricians can advocate for them in their communities. – by Katherine Bortz

Q: Is it common for schools to stock inhalers? Why or why not?

A: There is no current nationwide policy so that stock inhalers can be stocked in schools. In most schools located in states with stock albuterol policies who do not have a stock inhaler on site, they will have albuterol available for students who are not self-carrying. These inhalers will be given only to that individual.

Another individual might have asthma that is not documented or forgot to bring their inhaler if they self-carry. In this case, there would be no albuterol rescue inhaler available to that individual child.

Source: Adobe

Q: You mentioned that 12 states have expanded their stock epinephrine laws to include stock albuterol. What impact have these policies made?

A: There are not a lot of data, but some of the best data come out of Missouri, from their RESCUE program. They showed that when they stocked albuterol in their school, they used quite a bit. In the 2014-2015 school year, they used stock albuterol more than 1,700 times. Most of these children — about 85% of them — were able to return to class. I believe that in subsequent years, they have seen that number increase.

The overall concern is that you want to be able to use albuterol so a child does not have to go to the ED, and so they can return to school where they belong.


Q: What are some of the health consequences of giving stock inhalers to children who experience respiratory distress or asthma exacerbations?

A: Albuterol is the No. 1 medication that we use in an emergency for any child who has asthma and many other children that might not have diagnosed asthma but are experiencing respiratory distress. Use of albuterol can calm and alleviate those symptoms of an asthma attack or exposure to an environmental trigger such as perfume or exercise.

Q: In your editorial, you suggest ed that only certain people in states with stock inhaler policies can administer albuterol. What are some of the legal implications of administering stock albuterol?

A: The questions that came up when we discussed this in Illinois were: who gives it, and to whom? If an individual already has a diagnosis of asthma, giving them albuterol seems logical. Some states allow it to be given only to those who already have a diagnosis of asthma.

Perhaps a child might have shortness of breath for another reason. Giving albuterol might delay their care for a diagnosis such as pneumonia. This was a concern for some of the people of Illinois. However, albuterol does not have that many reported incidences of allergies, so the administration of albuterol is generally considered to be safe.

Q: What should pediatricians know about stock inhaler policies, and how can they advocate for these policies in schools?

A: The most important thing for pediatricians to know is that although we are giving albuterol prescriptions, they are not always consistently brought to school, and schools may not always have access to the medications that we think they do. What stock albuterol policies allow for is a fail-safe measure for a child who might be experiencing respiratory distress in school, where they spend many hours of their day. These policies will be crucial for allowing albuterol to be accessible to children who may forget it, not have it or not be diagnosed.

Pediatricians who want to advocate for these policies in their states should touch base with advocacy organizations like the American Lung Association and their regional chapters or other advocacy organizations, including legal and policy-driven groups.


Gerald JK, et al. Pediatr Allergy Immunol Pulmonol. 2012;doi:10.1089/ped.2011.0118.

Krieger J, et al. Ann Allergy Asthma Immunol. 2016;doi:10.1016/j.anai.2016.09.132.

Pappalardo AA, et al. Pediatrics. 2019;doi:10.1542/peds.2018-2857.

Disclosure: Pappalardo reports no relevant financial disclosures.