Stock Inhalers Save ER Trips, Keep Students in School

SAN DIEGO — Asthma afflicts 8.1% of school-age children in the United States and is a leading cause of missed school and work. Having stock inhalers available at schools prevents asthma-related emergency room visits, which can reduce healthcare costs and keep kids in classrooms, according to research presented here at the American Academy of Allergy, Asthma, & Immunology (AAAAI) 2025 Annual Meeting/World Allergy Organization.

To date, 24 states and the District of Columbia have passed laws allowing schools to stock and administer albuterol to anyone experiencing asthma symptoms on campus and without access to a personal inhaler. Yet even with stock inhaler laws in place, only two states fund these programs, and putting them into action is challenging.

In Chicago, where 12.9% of children have asthma and prevalence rises to 19.9% in predominantly Black areas, researchers conducted a pilot study to evaluate the feasibility and impact of a stock inhaler program in public schools. The pilot began with four schools in September 2023 and has since expanded to 316 schools serving more than 160,000 students. The team reported preliminary results at a February 28 AAAAI poster session.

During the 2023-2024 school year, stock inhalers were used at school 124 times — 120 times for asthma symptoms and 4 times as a preventive. In more than two thirds of cases, students were able to return to class after taking a few puffs from a stock inhaler. That meant they didn’t need to go home, and there were fewer trips to the emergency room, said Caroline Youssef, MD, MPH, a research associate working with Andrea Pappalardo, MD, associate professor of medicine and pediatrics at the University of Illinois College of Medicine in Chicago. “That’s really the key — minimizing school interruptions for these young kids.”

All pilot nurses completed training, and 61.3% of stock inhaler incidents followed Chicago public school dosing protocols. For mild-moderate asthma cases, 31.9% got fewer puffs than recommended, and for severe cases, 90.9% of cases received insufficient medication, suggesting that further dosing education is needed.

Meanwhile, Asthma and Allergy Impact and Rescue (AAIR), a nonprofit affiliated with the Asthma and Allergy Foundation of America, is working to equip schools with RESCUE — a program it has run since 2012 in St. Louis and more recently expanded to public schools across Missouri and Illinois.

Supported with state funding, RESCUE distributes inhalers and spacers according to schools’ student population and asthma burden and provides training for nurses and school staff. For the 2023-2024 school year, the state of Illinois invested $2.4 million to equip 3183 schools, and of those, 2171 (68%) enrolled in the program.

School health personnel log each incident into the RESCUE Illinois portal, where they also indicate what they would have done with the student if stock inhalers were unavailable — for example, send home with parent, call for emergency services.

When surveyed about the RESCUE program, 84.6% of nurses said they were satisfied or very satisfied, and 91.6% of schools indicated they would likely or very likely continue.

In addition to offering medical help, stock inhalers have a cost benefit. When a student gets sent to the emergency room, the average cost of that visit is about $3000. “We stock an entire school for less than a thousand dollars,” said Chris Martinez, AAIR’s president and CEO, who presented the RESCUE survey results on February 28 on an AAAAI poster. “So if we keep one kid out of the emergency department from every school in which we run the program, we’re saving money at a factor of 3 to 1. This program is about kids and cash.”

The pilot in Chicago public schools was supported by grants from the American Lung Association and the Agency for Healthcare Research and Quality. RESCUE studies were supported with funding from the Illinois Department of Public Health.

Esther Landhuis is a freelance science & health journalist in the San Francisco Bay Area, California. She can be found on X @elandhuis.