The prevalence of asthma in children makes it the most common chronic pediatric condition. Considering most days in a child’s life are spent at school, lacking access to inhalers during asthma emergencies is disconcerting. The Region IX – Western Region Public Health Training Center (WRPHTC) partnered with University of Arizona researchers to tackle this public health issue in Arizona schools.
Imagine a classroom of third-graders. They’re working in groups on a project, and suddenly a young man begins wheezing loudly. His classmates, alarmed, start to yell for the teacher, who’s focused on another group. The boy clutches his chest looking panicked.
State policies prohibit medications from being brought to school, leaving school administrators with only two options in a scenario like this: Call a parent to acquire a child’s inhaler or send the child to the emergency room for treatment.
“One of the scariest things for a teacher or school administrator to deal with is a child in respiratory distress,” said Dr. Lynn Gerald, in her testimony before the Arizona legislature’s health committee. Dr. Gerald, a professor of public health at the University of Arizona, partnered with officials and nurses from Sunnyside School District to pilot a stock albuterol program. “Despite the need for medication, 80 percent of children at school do not have their inhalers with them.”
Asthma affects roughly one in 10 children in the United States, making it the most common chronic pediatric condition and a frequent and unwelcome visitor in schools. In 2008, school-aged children suffering from asthma visited the emergency room 750,000 times and accumulated 10 million missed days of school. Asthma at school is an urgent problem and a real opportunity for public health training of teachers and school staffers.
Many schools lack a fail-safe system to respond promptly with medication to students in respiratory distress. This situation is improving in Arizona, thanks to a multi-organization policy effort to sanction schools to play a primary role in the safety of their students. Common sense public health solutions still require a journey from research to policy, and public health training plays an important role. In Arizona, an online asthma training provided schools the link toward sustainability.
During the year that Sunnyside schools had a stock inhaler available, the number of emergency room transports dropped by 40 percent. Still, without certifying non-health professionals to administer the inhaler, students in rural schools and schools without a nurse would still lose precious minutes waiting for relief.
University of Arizona researchers asked the Western Region Public Health Training Center (WRPHTC) to design an online training course that would qualify teachers, coaches and other school staff to administer the stock inhaler when confronted with a student in need.
Students and technical designers from WRPHTC collaborated with experts from the American Lung Association to create a simple online training course for school personnel. The training familiarizes staff with asthma basics, symptoms of onset and how to treat a student in respiratory distress.
In March 2017, the state legislature endorsed the effort, passing a bill, HB 2208, authorizing non-medical school personnel who completed the training to assist students in need of an inhaler. The training course became a key factor in the bill’s passing. Prior to this program and the legislation that followed, if an asthmatic student couldn’t breathe, the school had to call a parent to bring an inhaler in and, if the parent wasn’t immediately available, call an ambulance.
The process of treating students with asthma at school had been cumbersome before the new law. Lucinda Sorensen, a registered nurse with the Laveen Elementary School District, told Cronkite news: “The inhaler must be in its box with the prescription information on the label.” Sorensen remembered one time she couldn’t help a student right away. The student couldn’t find his inhaler, so he went to Sorenson’s office for help. But without access to a stock inhaler, her nursing skills weren’t going to help. “The school called the parent who brought it in for the child to use,” said Sorenson. “If we were unable to reach the parent, or if the situation was severe, we [would have called] the paramedics.”
Fear of liability had been a barrier against schools adopting a program wherein school staff participate in medical activities. Without any kind of certification, non-medical staff were cautious when dealing with medical issues — first calling parents, then 911 — and would not be able to act directly in an asthma emergency. When the bill reached the floor of the state’s health committee, online training was already in place for schools to implement their new stock inhaler programs.
The story became an example in Arizona of how researchers, educators, advocates, and schools can work together to address a significant public health problem — without the expense and obstacles of involving the formal healthcare system. It showed how, for a disease affecting so many children — with a quick-relief medicine like an inhaler — members of the public are more suitable health care workers than doctors.
When questioned in the legislative hearing about the safety of laymen administering albuterol to children, Dr. Gerald noted that the medication was quite safe and had no serious side effects. “Our physicians like to say the only way a child would be harmed would be if they swallowed the inhaler.”
Register for the Region IX – WRPHTC course, “Stock Albuterol Inhaler Training for School Personnel.”
A message from the course providers:
Asthma is life-threatening when students do not have the tools to manage symptoms effectively. The stock albuterol inhaler program provides an albuterol inhaler to be kept in the school health office (e.g., stock albuterol) in the event that a student is experiencing respiratory distress and does not have access to their own rescue inhaler. This e-learning course provides mandatory training for school personnel designated to administer the stock albuterol inhaler.
Course Objective: This training has been developed to assist in teaching school staff about asthma and administration of the stock albuterol inhaler. After completing the course, learners will be able to:
1. Understand the basic pathophysiology of asthma and identify potential asthma triggers.
2. Explain how quick relief medications (e.g., albuterol) work to treat respiratory distress.
3. Recognize mild-moderate and severe respiratory distress.
4. Demonstrate the correct technique for administering a metered dose inhaler with a spacer or valved-holding chamber.
5. Determine the course of action for managing mild-moderate and severe respiratory distress.
6. Describe maintenance of the stock rescue inhaler.
This course is made possible by the American Lung Association in Tucson Arizona, the Pima County Health Department, The Mel & Enid Zuckerman College of Public Health at the University of Arizona, and the Western Region Public Health Training Center.
Julia Landau, Lead Writer, Region IX – Western Region Public Health Training Center
Lubna Govindarajan, Senior Program Coordinator, Region IX – Western Region Public Health Training Center
Raymond Andrade, Instructional Specialist Coordinator, Region IX – Western Region Public Health Training Center