Reason: For children with asthma, access to rapid relief medications is essential to minimize morbidity and mortality. An innovative and practical approach to ensuring access to school is to maintain a supply of albuterol that can be used by any student who is out of breath. To make this possible, state laws are needed that allow access to medicines in order to improve access to medicines. The content of stock albuterol training for school staff should include 1) signs and symptoms of shortness of breath; 2) an overview of asthma medications, which includes the administration, technique, maintenance and cleaning of the inhaler; and 3) a protocol for the treatment of respiratory episodes. Opportunities to teach again are especially important to ensure the right technique. Training should be provided by individuals with the necessary knowledge and expertise in asthma and albuterol policy. School nurses are key professionals who can provide and/or facilitate Albuterol training for school staff. Partnerships with local organizations and/or coalitions (e.g., American Lung Association, Allergy and Asthma Network) are also encouraged. Because children with asthma can experience a sudden, unexpected and life-threatening exacerbation at any time, access to albuterol can save lives. Although rare, there were a total of 192 asthma-related deaths in children in 2018 (1) and 38 school-related asthma-related deaths between 1990 and 2003 (24). Delays in the administration of albuterol were reported in one-third of these deaths, and one-third of the delays were attributed to a lack of medication. Asthma-related deaths have also occurred among school sports team athletes, and up to 10% of high school athletes have undiagnosed asthma (25). At school, Altbuterol should be stored in a temperate, dry and unlocked place, which is easily accessible to people trained for the administration of drugs.
The expiration date of medications should be monitored. All drugs should be disposed of on the basis of school procedures. Each item reflects a pharmacare program that existed in place from 2004 to 2006 and from 2009 to 2010 (a total of 32 plans). The horizontal axis shows the average expenditures of each regimen for an albuterol inhaler prescription equivalent to 30 days from 2004 to 2006, calculated for all people on a plan who completed an albuterol prescription during those years. The vertical axis shows the change in dollar terms in the average cost of lculinated albuterol inhalers for a given regime between 2004 and 2006 and from 2009 to 2010. The Severe Acute Respiratory Syndrome Coronavirus 2 pandemic has changed the practices surrounding the administration of albuterol via nebulizers. Nebulizers are not recommended in school during the pandemic, as infectious aerosols can spread. Instead, standard albuterol MDIs can be used if properly cleaned after use with a single disposable HCV/spacer for each child.
According to CDC guidelines, appropriate personal protective equipment should be used by the employee to help administer inhaled or fogged medications, and medications should not be administered in class with other children present (45). Ideally, schools can increase supplies using the annual budget for school health. Alternative mechanisms include donations of products or money from interested organizations (e.g., pharmaceutical companies, patient advocacy groups, hospitals), discounts or reimbursements from pharmaceutical companies, or fundraising by existing stakeholders such as parent-teacher groups. Current programs cost less than $85.00 (in 2020) for an albuterol inhaler and require supplies for a school (29). Program costs may be influenced by the number of inhalers needed at school. We recommend at least one rapid relief inhaler per school building, with additional inhalers added depending on student enrollment, school layout (p. e.g., number of buildings, location of playgrounds and fields) and prevalence of asthma. We used national drug codes to identify pharmacy claims for albuterol metered-dose inhalers.
Mail order and 90-day receipts were included. We classified albuterol inhalers as generic CFC inhalers, branded CFC inhalers or HFA inhalers. We also identified pharmacy claims for asthma control drugs that included inhaled corticosteroids, long-acting beta-agonists, leukotriene receptor antagonists, combination formulations of long-acting beta-agonist corticosteroids, methylxanthines, cromolyn sodium and immunomodulators. Average spending on albuterol inhalers remained stable at $13.60 (95% CI, $13.40 to $13.70) per prescription from the first quarter of 2004 to the fourth quarter of 2006 and increased to $19.90 (95% CI, $19.70 to $20.10) in the first quarter of 2007 as CFC inhalers expired. Average spending peaked at $25.00 (95% CI, $24.80 to $25.20) in the first quarter of 2009 after the ban came into effect and fell to $21.00 (95% CI, $20.80 to $21.20) in the fourth quarter of 2010 (Figure 1A). Average spending declined slightly quarterly over the course of each year, reflecting a greater proportion of people who have deductibles out of their own pockets throughout the year. A letter of reflection is a two- to four-page summary of an identified problem with recommendations for solutions (see online supplement) (32). In the case of basic albuterol, this letter provides a brief summary of the prevalence, morbidity and mortality of asthma; underlines the State`s asthma policy; and describes similar laws in other states.
The letter also highlights how existing asthma policies have influenced change. If you are looking to change existing legislation (for example, adrenaline for anaphylaxis), it is useful to include all the positive results of this legislation. The reduction in stratospheric ozone has been associated with higher rates of melanoma and non-melanoma skin cancer, photokeratitis, and cataracts.27–29 Although the intended effect of the FDA`s ban on CFCs has been to reduce these health risks by eliminating CFC products, our results suggest that the policy has also led to a moderate decline in the use of albuterol inhalers among private insured persons and has led to a sharp relative increase in spending. Significant declines in usage may also have occurred among uninsured individuals for whom we did not have data.