Unassigned Albuterol Legislation




Murthy, Bharati
Chaudhari, Sampada
George, Kevin


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Introduction: Asthma is a reversible chronic obstructive lung disease that affects over 6 million children ages 0-17 in the United States. An asthma attack is sudden and can be triggered by allergens such as mold, dust, cold weather, or tobacco. An asthma attack leads to airway narrowing through smooth muscle constriction, excess mucous production, and inflammation. Symptoms include chest tightness, wheezing, and anxiety. Acute asthma symptoms are commonly managed through short-acting beta agonists (SABA) like albuterol and best practice guidelines recommend these medications always be available to those with the condition. However, data suggests that only 20% of students with a diagnosis of asthma have access to albuterol in schools. To increase access to SABA among students experiencing respiratory distress, schools may "stock” albuterol and adopt standing delegation orders issued by a consulting physician. This is referred to as "unassigned albuterol.” According to the Asthma and Allergy Foundation of America (AAFA), there are 14 states with legislation in place regarding the use and administration of unassigned albuterol in K-12 schools. In 2021, national professional organizations endorsed guidelines that identified 4 essential components and 4 recommended components for state legislation regarding unassigned albuterol. The purpose of this study is to investigate alignment of existing state legislation with the 2021 national guidelines.

Methods: The stock albuterol legislation was obtained from each state’s online repository of legislation and systematically reviewed by two independent researchers to assess whether or not it was aligned with each of the essential and suggested components of the national guidelines. Where there was lack of consensus on alignment, the component was reviewed by the full research team. A matrix was created presenting these findings.

Results: From our comparative analysis of the fourteen states that currently have legislation for unassigned albuterol administration, we observed a widespread lack of alignment with national guidelines. All states had at least one essential or recommended component that was not aligned with guidelines. States ranged from a low of one misaligned component, to a high of six misaligned components. Among essential components of the guidelines, the recommendation for training was particularly problematic as it was only fully addressed by three states, was partially addressed by 8 states, and unaddressed by three states.

Conclusion: This study highlights the lack of alignment between existing state legislation and national guidelines. It also highlights the importance of national guidelines to inform policy that supports implementation of best practice. For those 36 states that have not yet established legislation for unassigned albuterol, these results may help identify potential models for policy that aligns with national guidelines and supports best practice to meet the needs of children with asthma at school. Additionally, results suggest that training requirements for school health staff may benefit from greater attention from state and national stakeholders responsible for school asthma services, and by those involved in policy.


Research Appreciation Day Award Winner - Texas College of Osteopathic Medicine, 2023 Pediatric Research Award