Breathing Easy: A Qualitative Analysis of School Nurse and Administrator Perspectives on Stock Inhalers and School-Based Asthma Management

Abstract

Stock inhalers are unassigned rescue inhalers available for students who experience asthma symptoms at school. This study sought to understand school nurse and administrator perspectives on school-based asthma management and stock inhaler policy implementation. Twenty-three semistructured interviews were conducted with professionals from five high asthma burdened counties in varied geographic settings. Thematic analysis revealed three themes. “School-Based Asthma Management” revealed concerns about management methods of asthma and respiratory emergencies, and incident tracking. “Access to a Supportive Asthma School Environment” emphasized growth opportunities for family education, staff training, and resource access. “Stock Inhaler Programming” described how stock inhalers ensure consistent asthma medication access with easy integration into existing emergency protocols. With proper adoption and dissemination, stock inhaler programming has the capacity to enhance school-based asthma management and emergency responsiveness in schools across the country. This study highlights how health policy implementation and its integration into practice can transform school health.

Keywords

asthma albuterol pediatrics schools health policy school nurses

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References

American Academy of Allergy Asthma & Immunology (AAAAI). (2023). Stock inhaler toolkit for schools. American Academy of Allergy Asthma & Immunology. https://www.aaaai.org/tools-for-the-public/school-tools/sampro/stock-inhaler

American Academy of Allergy, Asthma, & Immunology (AAAAI). (n.d.). The school-based allergy, asthma and anaphylaxis management program®: comprehensive asthma educational resources. https://www.aaaai.org/tools-for-the-public/school-tools/sampro

American Lung Association. (n.d.). Model policy for school districts: Stock bronchodilators. https://www.lung.org/getmedia/96873d5c-3a30-4be6-9a3c-445a2dafdd7b/model-policy-on-stock-bronchodilators.pdf

Arenson

Hudson

P. J.

Lee

Lai

(2019). The evidence on school-based health centers: A review. Global Pediatric Health, 6(Jan-Dec), 2333794X–21982874. https://doi.org/10.1177/2333794X19828745

ASCD & Centers for Disease Control and Prevention. (n.d.). Whole school, whole community, whole child. https://www.cdc.gov/healthyschools/wscc/WSCCmodel_update_508tagged.pdf

Asthma & Allergy Foundation of America (AAFA). (2023). Albuterol in schools. Asthma & Allergy Foundation of America. https://aafa.org/advocacy/key-issues/access-to-medications/albuterol-in-schools/

Asthma and Allergy Foundation of America, St. Louis Chapter (AAFA-STL). (n.d.). School programs. https://aafamidstates.org/how-we-help/school-programs/

Butler

S. M.

Boucher

E. A.

Tobison

Phan

(2020). Medication use in schools: Current trends, challenges, and best practices. The Journal of Pediatric Pharmacology and Therapeutics, 25(1), 7–24. https://doi.org/10.5863/1551-6776-25.1.7

Caruana

West

L. M.

Cordina

(2021). Current asthma management practices by primary school teaching staff: A systematic review. Journal of School Health, 91(3), 227–238. https://doi.org/10.1111/josh.12992

10.

Centers for Disease Control and Prevention. (2022). Asthma | healthy schools | CDC. CDC Healthy Schools. https://www.cdc.gov/healthyschools/asthma/index.htm

11.

Centers for Disease Control and Prevention. (2023). Most recent national asthma data. CDC: Asthma. https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm

12.

Dedoose. (2021). Version 9.0.17, cloud application for managing, analyzing, and presenting qualitative and mixed method researc data. Socio Cultural Research. Consultants.

13.

Esty

Permaul

DeLoreto

Baxi

S. N.

Phipatanakul

(2019). Asthma and allergies in the school environment. Clinical Reviews in Allergy & Immunology, 57(3), 415–426. https://doi.org/10.1007/s12016-019-08735-y

14.

Gerald

J. K.

Stroupe

McClure

L. A.

Wheeler

Gerald

L. B.

(2012). Availability of asthma quick relief medication in five Alabama school systems. Pediatric Allergy, Immunology, and Pulmonology, 25(1), 11–16. https://doi.org/10.1089/ped.2011.0118

15.

Gereige

R. S.

Gross

Jastaniah

, & Council on School Health and Committee on Pediatric Emergency Medicine. (2022). Individual medical emergencies occurring at school. Pediatrics, 150(1), e2022057987. https://doi.org/10.1542/peds.2022-057987

16.

Gracy

(2018). Managing childhood asthma as a strategy to break the cycle of poverty. American Journal of Public Health, 108(1), 21–22. https://doi.org/10.2105/AJPH.2017.304195

17.

Grant

Croce

Matsui

E. C.

(2022). Asthma and the social determinants of health. Annals of Allergy, Asthma & Immunology, 128(1), 5–11. https://doi.org/10.1016/j.anai.2021.10.002

18.

Hardy

Gonzalez

Lane

Yonkaitis

C. F.

Pappalardo

A. A.

(2024a). Stock inhalers for schools. Annals of Allergy, Asthma & Immunology, 132(4), 532–534. https://doi.org/10.1016/j.anai.2023.12.001

19.

Hardy

Gonzalez

Volerman

Salem

Amerson

Woolverton

Geiger

S. D.

Pappalardo

A. A.

(2024b). Asthma policy in Illinois: A survey of school nursing and staff knowledge and implementation patterns. Public Health Nursing, 41(4), 704–708. https://doi.org/10.1111/phn.13337

20.

Illinois Department of Public Health. (2016). Illinois childhood asthma surveillance report, 2011-2014. Illinois Department of Public Health. https://dph.illinois.gov/content/dam/soi/en/web/idph/files/publications/publicationsowh2016-il-childhood-asthma-surveillance-report-0.pdf

21.

Illinois Department of Public Health. (2024). Administration of undesignated asthma medications in school (2024): Standing order and protocol. https://dph.illinois.gov/content/dam/soi/en/web/idph/resources/topics-services/diseases-and-conditions/asthma/albuterol-standing-order-02-29-24.pdf

22.

Israel

B. A.

Schulz

A. J.

Parker

E. A.

Becker

A. B.

(1998). Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19(1), 173–202. https://doi.org/10.1146/annurev.publhealth.19.1.173

23.

Jhun

Gaffin

J. M.

Coull

B. A.

Huffaker

M. F.

Petty

C. R.

Sheehan

W. J.

Baxi

S. N.

Lai

P. S.

Kang

C.-M.

Wolfson

J. M.

Gold

D. R.

Koutrakis

Phipatanakul

(2017). School environmental intervention to reduce particulate pollutant exposures for children with asthma. The Journal of Allergy and Clinical Immunology: In Practice, 5(1), 154–159.e3. https://doi.org/10.1016/j.jaip.2016.07.018

24.

Kiger

M. E.

Varpio

(2020). Thematic analysis of qualitative data: AMEE guide no. 131. Medical Teacher, 42(8), 846–854. https://doi.org/10.1080/0142159X.2020.1755030

25.

Leroy

Z. C.

Wallin

Lee

(2017). The role of school health services in addressing the needs of students with chronic health conditions: A systematic review. The Journal of School Nursing, 33(1), 64–72. https://doi.org/10.1177/1059840516678909

26.

Lowe

A. A.

Gerald

J. K.

Clemens

C. J.

Stern

D. A.

Gerald

L. B.

(2021). Managing respiratory emergencies at school: A county-wide stock inhaler program. Journal of Allergy and Clinical Immunology, 148(2), 420–427.e5. https://doi.org/10.1016/j.jaci.2021.01.028

27.

McClure

Catrambone

Carlson

Phillippi

(2020). Maximizing the role of the nurse: Strategies to address gaps in asthma care in schools. Journal of Pediatric Nursing, 53(Jul-Aug), 52–56. https://doi.org/10.1016/j.pedn.2020.05.003

28.

Mell

H. K.

Mumma

S. N.

Hiestand

Carr

B. G.

Holland

Stopyra

(2017). Emergency medical services response times in rural, suburban, and urban areas. JAMA Surgery, 152(10), 983. https://doi.org/10.1001/jamasurg.2017.2230

29.

Mickel

C. F.

Shanovich

K. K.

Evans

M. D.

Jackson

D. J.

(2017). Evaluation of a school-based asthma education protocol: Iggy and the inhalers. The Journal of School Nursing, 33(3), 189–197. https://doi.org/10.1177/1059840516659912

30.

Missouri Department of Health and Senior Services & Missouri School Health Program (2018). Emergency medications: Policies and practices in Missouri schools 2018.

31.

Naja

A. S.

Permaul

Phipatanakul

(2018). Taming asthma in school-aged children: A comprehensive review. The Journal of Allergy and Clinical Immunology: In Practice, 6(3), 726–735. https://doi.org/10.1016/j.jaip.2018.01.023

32.

Nanda

Siles

Park

Louisias

Ariue

Castillo

Anand

M. P.

Nguyen

A. P.

Jean

Lopez

Altisheh

Pappalardo

A. A.

(2023). Ensuring equitable access to guideline-based asthma care across the lifespan: Tips and future directions to the successful implementation of the new NAEPP 2020 guidelines, a work group report of the AAAAI Asthma, Cough, Diagnosis, and Treatment Committee. Journal of Allergy and Clinical Immunology, 151(4), 869–880. https://doi.org/10.1016/j.jaci.2023.01.017

33.

O’Rourke

Zimmerman

Platt

Pappalardo

A. A.

(2020). Preventing asthma emergencies in schools. Pediatrics, 145(4), e20191995. https://doi.org/10.1542/peds.2019-1995

34.

Papp

E. M.

Gerald

J. K.

Sadreameli

S. C.

Gerald

L. B.

(2019). Why every school should have a stock inhaler: One nurse’s experience. American Journal of Public Health, 109(11), 1528–1529. https://doi.org/10.2105/AJPH.2019.305314

35.

Pappalardo

A. A.

Wang

Martin

M. A.

(2023). CHECK—multilevel real-world pediatric asthma care coordination: Results and lessons learned. Journal of Asthma, 60(6), 1061–1071. https://doi.org/10.1080/02770903.2022.2129063

36.

Patton

M. Q.

(2023). Qualitative research & evaluation methods: Integrating theory and practice (4th ed.). Sage Publications.

37.

Phipatanakul

(2021). School Innercity Asthma Intervention Study (SICAS-2) (SICAS-2). ClinicalTrials.Gov. https://classic.clinicaltrials.gov/ct2/show/NCT02291302

38.

Phipatanakul

(2022). Environmental intervention to reduce allergens in urban schools and childhood asthma. ClinicalTrials.Gov. https://clinicaltrials.gov/study/NCT01913795?locStr=Boston,%20MA&country=United%20States&state=Massachusetts&city=Boston&cond=Asthma%20&intr=school%20environment&rank=1

39.

Phipatanakul

Koutrakis

Coull

B. A.

Kang

C.-M.

Wolfson

J. M.

Ferguson

S. T.

Petty

C. R.

Samnaliev

Cunningham

Sheehan

W. J.

Gaffin

J. M.

Baxi

S. N.

Lai

P. S.

Permaul

Liang

Thorne

P. S.

Adamkiewicz

Brennan

K. J.

Baccarelli

A. A.

, … Gold

D. R.

(2017). The school inner-city asthma intervention study: Design, rationale, methods, and lessons learned. Contemporary Clinical Trials, 60(Sept), 14–23. https://doi.org/10.1016/j.cct.2017.06.008

40.

S. Q.

Dumay

(2011). The qualitative research interview. Qualitative Research in Accounting & Management, 8(3), 238–264. https://doi.org/10.1108/11766091111162070

41.

Respiratory Health Association. (2020). Report on asthma policy in Illinois schools: knowledge, implementation and challenges. https://resphealth.org/wp-content/uploads/2021/02/Illinois-Asthma-Policies-Schools-Report.pdf

42.

Illinois Department of Public Health. (n.d.). Illinois behavioral risk factor surveillance system. Illinois Department of Public Health. Retrieved December 1, 2023, from https://idph.illinois.gov/brfss/default.asp

43.

Rood

Osborne

Krieger

Gaddy

Armbrecht

Francisco

(n.d.). A state law permitting stock asthma rescue medicines in the school setting. https://asthmaready.org/wp-content/uploads/2014/06/StateLawPermittingStockAsthmaRescueMeds.pdf

44.

Sanders

(2023). The administration of undesignated asthma medication, school year 2022-23. Illinois State Board of Education.

45.

Schencker

(2024). Illinois legislature passes bill to limit cost of inhalers to $25 a month. Chicago Tribune. https://www.chicagotribune.com/2024/05/23/illinois-legislature-passes-bill-to-limit-cost-of-inhalers-to-25-a-month/

46.

Serebrisky

Wiznia

(2019). Pediatric asthma: A global epidemic. Annals of Global Health, 85(1), 6. https://doi.org/10.5334/aogh.2416

47.

Stock Albuterol in Schools Act, Pub. L. No. SB 3015 (2018). https://www.ilga.gov/legislation/publicacts/100/PDF/100-0726.pdf

48.

Swain

(2018). A hybrid approach to thematic analysis in qualitative research: Using a practical example. Sage Publications Ltd.

49.

National Association of School Nurses, Tanner

Griffin

Stanislo

K. J.

Hinkley

Walsh

C. A.

Clark

Graf

La Point

D’Souza-Vazirani

(2024). A contemporary framework update for today’s school nursing landscape: Introducing the school nursing practice framework™. NASN School Nurse, 39, 3, 2024, 140–147. https://doi.org/10.1177/1942602X241241092

50.

Thayer Medical. (n.d.). LiteAire MDI holding chamber. Thayer Medical. https://thayermedical.com/products/liteaire/

51.

Tong

Sainsbury

Craig

(2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357. https://doi.org/10.1093/intqhc/mzm042

52.

Volerman

Lowe

A. A.

Pappalardo

A. A.

Anderson

C. M. C.

Blake

K. V.

Bryant-Stephens

Carr

Carter

Cicutto

Gerald

J. K.

Miller

Moore

N. S.

Phan

Sadreameli

S. C.

Tanner

Winders

T. A.

Gerald

L. B.

(2021). Ensuring access to albuterol in schools: From policy to implementation. An official ATS/AANMA/ALA/NASN policy statement. American Journal of Respiratory and Critical Care Medicine, 204(5), 508–522. https://doi.org/10.1164/rccm.202106-1550ST

53.

Williams

Moser

(2019). The art of coding and thematic exploration in qualitative research. International Management Review, 15(1), 45–55.

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