Every week I meet parents of children with asthma who tell me they get nervous sending their children to school, unsure whether they will have a sudden asthma attack without rescue medication nearby. Fortunately, these children are one step closer to breathing a little easier.
That’s because during the 86th Texas legislative session, HB 2243 was signed into law. This legislation permits schools, both public and private, to stock asthma rescue medication for emergency use. For the children struggling to control asthma whom I see in the clinic and hospital as a pediatric resident, this is a major deal.
According to the Centers for Disease Control and Prevention, asthma is the most common chronic disease of childhood. Nearly 1 in 5 youths in Texas has asthma. Often they might feel chest tightness at rest or recess, a cough, or a wheeze that quickly spirals out of control into suffocating shortness of breath. Rescue asthma medication works quickly to open their airways to allow normal breathing to resume. At school, youths might find themselves in need of rescue medication for many reasons. They might forget theirs at home, it might be expired, or it might be depleted.
Stock asthma medication is widely endorsed by the American Academy of Pediatrics, the National Association of School Nurses, the Asthma and Allergy Foundation of America and the American Lung Association. Sadly, only 12 other states possess similar stock medication laws for schools. With the signing of this bill, Texas emerges as a leader in this regard.
However, HB 2243 was only the first step. More remains to be done. Local school boards must prioritize developing this policy. They have help to do it. The Texas Stock Epinephrine Advisory Committee will soon meet to make recommendations for how schools can implement the law. The goal is to establish a rule that has flexibility and allows schools to adapt policies that meet their specific situations. The American Lung Association provides model templates to help school boards do just that. The Texas Association of School Boards can help guide school leaders as they’ve done successfully with stock emergency epinephrine policy passed in 2015.
Stock asthma medication will save schools money. The CDC reports that more than half of youths with asthma will have an attack every year, causing many children to miss school. Texas schools lose money when students are absent, and, according to the Barbara Bush Houston Literacy Foundation, absenteeism amounts to tens of millions of dollars lost each year in our schools. This lost revenue affects all students.
School nurses, often the leaders in developing school medication administration procedures, play a crucial role. In other states, nurses consistently report high satisfaction with stock asthma medication programs. A major reason — they need to make fewer 911 calls. School nurse leaders should be involved early on to help guide policy implementation.
Pediatricians need to collaborate with schools and the Texas Department of State Health Services to prescribe asthma medication, just as they do with epinephrine used to treat severe allergic reactions. Importantly, these prescriptions do not need to be patient-specific (termed “unassigned”), meaning they can be administered to any child in an emergency situation. The Texas DSHS plans to develop standard prescription forms that pediatricians can use for schools. Pharmacists are permitted by the new law to honor these prescriptions just as they would for individual patients.
Parents now have additional support to help keep their children healthy and avoid excessive medical costs from uncontrolled asthma. Parents should communicate to their children’s school the importance of stocking asthma medications, but must also continue to ensure their children have their personal asthma medication with them while at school.
We all must work together for the health and safety of children. HB 2243 recognizes all parties involved and gives each the power to achieve the goal they all share: keeping kids healthy so they can achieve their full potential.
Tabb is a pediatric resident at Texas Children’s Hospital and Baylor College of Medicine.
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Respiratory system