P3B215: Investigating Policy and Best Practice Guidelines to Improve School Asthma Services: Unassigned Albuterol Legislation

Background: 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 leads to airway narrowing through smooth muscle constriction, excess mucous production, and inflammation. Symptoms include chest tightness, wheezing, and anxiety. Short-acting beta agonists (SABA) are commonly used to manage acute asthma symptoms, and best practice guidelines recommend these medications always be available to those with the condition.
However, evidence indicates that only 20% of K-12 students with asthma have access to SABA in schools. To increase access to SABA among students, schools may "stock" albuterol and adopt standing delegation orders issued by a consulting physician, referred to as "unassigned albuterol." According to the Asthma and Allergy Federation of America, 14 states are reported to currently have legislation regarding the use and administration of unassigned albuterol in schools. In 2021, national professional organizations endorsed and published policy guidelines that include four essential components and four recommended components of state legislation regarding unassigned albuterol. However, to our knowledge, there has yet to be an investigation of alignment between national guidelines and existing state legislation.

Methods: We obtained current stock albuterol legislation from each state's online repository of legislation. Two independent researchers systematically reviewed each state's legislation to assess whether it aligned with the essential and suggested components of the national guidelines. Where there was a lack of consensus on alignment, the full research team reviewed the component. A matrix was created presenting these findings.

Results: Our comparative policy analysis of the fourteen states that are identified to have unassigned albuterol legislation indicated a widespread lack of alignment with national guidelines. All states had at least one essential or recommended component 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 eight states, and was unaddressed by three states.

Conclusion: This study highlights a need for greater alignment between existing state legislation and national guidelines and the importance of national guidelines to inform policy that supports the implementation of best practices. It may be especially informative for pediatricians engaged in policy advocacy, community asthma coalitions, or the provision of medical consultation to school districts. For the 36 states without current legislation, these results may help identify potential models for policy that align with national guidelines and support best practices to meet the needs of children with asthma at school. Additionally, greater attention to training requirements may be especially important for state and national stakeholders.