Table 3.

Essential and Suggested Components of Stock Albuterol Legislation

Component	Explanation/Reasoning
Essential components
Medication can be administered in good faith to any child in respiratory distress.	The bill should permit emergency use of stock albuterol for any student in respiratory distress, not only students known to have an asthma diagnosis.
	Reasoning:
	• Many students have undiagnosed asthma and may have their first asthma exacerbation at school.
	• Emergency administration of albuterol may be necessary and time sensitive; review of records to determine whether a student has asthma may delay care.
	• There are few causes of respiratory distress in children that would not respond to or would be harmed by administration of albuterol.
	• Albuterol is a safe medicine.
Establish training requirements for school staff.	The bill should outline details about how many staff should be trained and about how training should be conducted to ensure that enough staff have the necessary knowledge and skills to administer stock albuterol.
	• The recommendation is that a minimum of two individuals be trained per school building at a ratio of one individual for every 225 students.
	• Recommend permitting live or remote training that can be accessed by school staff at a convenient time at no cost.
Ensure immunity from civil liability for staff and prescribers.	The bill should provide:
	• Immunity for medical professionals who write the orders as well as pharmacists who dispense orders.
	• Immunity for school districts, school staff, or agents of the school who have the required training and administer the albuterol in good faith.
Ensure that pharmacy laws allow medication dispensing to schools.	In parallel with preparing legislation, review the state’s current pharmacy dispensing laws and assess whether it is necessary to update pharmacy state board laws. Specifically, it is important that pharmacies are able to dispense medication to a school/district rather than to a specific individual.
Suggested components
Allow schools to accept donations of money or product.	Donations can help with financing for the implementation of stock albuterol programs.
Use metered-dose inhalers with VHCs/spacers.	Metered-dose inhalers with VHCs/spacers for administration of quick-relief medication allows for the inhaler to be used for multiple individuals with less cleaning, easier storage/portability, and reduced aerosolization of particles.
Ensure authorization of parents or caregivers/school volunteers to administer albuterol.	Include parents or caregivers as well as school volunteers as authorized administrators of stock albuterol to ensure that they are indemnified from good faith use if they have appropriate training.
	• There are many situations in which parents or caregivers as well as school volunteers act as agents of the school, such as during after-school activities, field trips, and sports.
Ensure inclusion of nonpublic schools (e.g., private, tribal).	States often do not have significant oversight for activities in nonpublic (e.g., private, tribal) schools, as they are not state licensed.
	• Stakeholders should explore state-specific strategies with legislators to include nonpublic schools in legislation.
	• Even if a school does not fall under state licensing requirements, prescribing providers and dispensing pharmacists need to legally be able to provide stock albuterol for nonpublic schools.

Definition of abbreviation: VHC = valved holding chamber.