Objective: Pediatric asthma health disparities are common. Schools often lack asthma diagnostic information and infrastructure to handle asthma symptoms. Undesignated or stock rescue inhalers available to anyone in respiratory distress can help prevent absences.
Methods: A stock inhaler pilot program was conceptualized and evaluated using implementation science frameworks. Districts from high-asthma-burden counties were engaged and offered guided implementation over the 2022-2023 or 2023-2024 school year. Districts were required to complete training and report stock inhaler incidents. Pre/post implementation interviews and surveys were performed to assess acceptability, feasibility, fidelity to emergency protocols, satisfaction, and utilization. Descriptive statistics were calculated for surveys and utilization data. Thematic data analysis was performed on interview transcripts.
Results: Fourteen pilot schools from six districts served 10,265 children. Twenty-eight stock inhaler events were documented. The majority of children (75%) using the stock inhaler had known asthma. Of the 24 events for which disposition was reported, 12 students returned to class (50%), 10 left school with a parent (42%), and only two were transported by emergency services (8%). Pre-implementation interviews revealed that school nurses were concerned about family asthma education (76%) and staff training (29%). One interviewee described the program as "a sturdy safety net… if you can't breathe, nothing else matters". All schools intended to continue stocking inhalers.
Conclusions: Stock inhaler programming was well received and improved student outcomes. Resources for Every School Confronting Unexpected Emergencies-Illinois (RESCUE-IL) secured state funding in Illinois to expand stock inhaler programming to over 80% of Illinois public schools. Multi-level, community-focused interventions can maximize the impact of health policies.
Keywords: Asthma; health status disparities; implementation science; pediatrics; qualitative research; school health services; school nursing.