Back-to-school time means a flare-up of asthma problems in children, but students may not be getting the access they need to their medication—despite state laws meant to ensure their right to carry and use inhalers.
An online survey by the American Lung Association has just found that nearly three quarters of parents of children who bring so-called "relief inhalers" to school say that school officials do not allow the children to keep the medication in their desks or pockets. Schools are limiting access to the medication, which opens breathing passages quickly in the case of an asthma attack, despite laws in 46 states and the District of Columbia requiring that self-administration of asthma drugs be allowed in public and private schools. Schools' restrictive interpretation of these laws, often requiring that students seek permission from the nurse to administer the medication, could lead to emergencies, says Norman Edelman, ALA's chief medical officer.
Children should be able to use their inhalers as soon as needed, he says, "when their chest begins to tighten up, when they've run too hard or, for some kids, if they've just laughed too hard. The sooner a bronchospasm is addressed, the easier it is to control. If you let it go on, inflammation increases and it's kind of a vicious cycle." Edelman says schools have enacted blanket no-drug policies without taking into account that the inhalers contain an airway-specific muscle relaxant with little if any effect elsewhere in the body. "We don't know of any significant abuse," he says. "It's not a good high."
Today, when the National Institutes of Health released its first comprehensive update in a decade of clinical guidelines for the diagnosis and management of asthma, the expert panel greatly expanded its recommendations on the disease in children, and noted that "reliable, prompt access to medication is essential" in schools.
The concerns about school policies come at a time of increased evidence of a September worsening of symptoms among the more than 6.5 million American children under age 18 with asthma. The Journal of Allergy and Clinical Immunology this summer reported a highly predictable increase in emergency room visits, hospital admissions, and unscheduled doctor visits for childhood asthma at back-to-school time. The American Association of School Administrators says it is working with the lung association to improve its members' ability to address asthma management in schools. The only states that don't have laws protecting students' right to inhalers are Connecticut, Louisiana, South Dakota, and Vermont.
Tips for parents of children with asthma can be found at lungusa.org, including how to put an asthma action plan in place for your child both at home and at school.