Funded projects

Implementing Stock Albuterol Program in Massachusetts

Project Year

2026

City & State

Boston, Massachusetts

Program Name

Resident

Topic

Asthma

Program Description

"Problem Asthma is one of the most common chronic pediatric conditions and a leading cause of school absenteeism and emergency care utilization. In Massachusetts, approximately 9.6% of children have asthma, impacting both urban and rural communities (1,2). A critical component of asthma management is timely access to albuterol, a short-acting bronchodilator that provides rapid relief during acute exacerbations and can be life-saving. However, access to albuterol in schools is inconsistent. Children may not have their rescue inhaler available due to administrative requirements, school policies, and barriers to medication access. When rescue medication is unavailable at the moment of need, there is increased risk of severe exacerbations, emergency department (ED) visits, and missed school days (3). The American Lung Association emphasizes access to rescue medication as essential to effective school-based asthma care (4). Further, the American Thoracic Society supports stock albuterol at schools: a supply of albuterol inhalers that can be used by any child in respiratory distress (5).  While 23 states have enacted stock albuterol laws allowing schools to maintain albuterol for emergency use, Massachusetts lacks statewide legislation (6). This limits emergency preparedness and perpetuates inequities in pediatric asthma care, particularly for communities facing barriers to medication access.  

Primary Setting  This project will operate in two primary settings. First, a pilot stock albuterol program will be implemented in two Massachusetts elementary schools, one urban and one rural, over a six-month respiratory viral season. Second, the project will engage stakeholders statewide to support policy change.  

Number of Children Affected  This project will impact 9.6% of Massachusetts children living with asthma, with direct pilot-level impact on students attending the two participating schools: Clinton Elementary (870 students) and a Boston Public School (200-800 students).    

Project Goals  1.    Build a statewide stakeholder coalition to support legislation authorizing stock albuterol in Massachusetts schools. 2.    Implement and evaluate stock albuterol programs in one urban and one rural elementary school to demonstrate feasibility, safety, and clinical impact. 3.    Increase awareness and operational understanding among school nurses and school health leaders regarding stock albuterol implementation.  Intervention Each school will be supplied with albuterol inhalers and protocols for administration and documentation. School nurses will receive training, and educational materials (7) will be provided to caregivers. Data will be collected on asthma prevalence, inhaler access, stock albuterol use, school absences, and ED visits based on school nursing reports. We will compare data between the pilot year and preceding school year to evaluate the impact of stock albuterol.   Concurrently, we will partner with the Massachusetts School Nurses Association and other stakeholders (health professionals, state legislators, families, community advocates) to convene a coalition that meets at least two times to develop a strategic plan for statewide legislation.  Outcomes -    Number and characteristics of students treated with stock albuterol. -    Clinical outcomes (symptom relief, need for EMS or ED transfer). -    Impact on school nurse workflow. -    Caregiver acceptance. -    Cost data and potential healthcare savings.  Together, these outcomes will generate Massachusetts-specific evidence to support equitable, statewide adoption of stock albuterol in schools. "

Project Goal

The overarching goal of this project is to improve equitable access to timely, life-saving asthma care for children in Massachusetts by building a statewide stakeholder coalition to support stock albuterol legislation and by piloting and evaluating school-based stock albuterol programs that demonstrate feasibility, safety, and clinical impact while increasing awareness and capacity among school nurses and school health leaders.

Project Objective 1

By month 6, we will have identified an inclusive, multidisciplinary stakeholder coalition of at least 12 members across school health, pediatrics, advocacy, and legislative sectors and by month 12 this coalition will have met at least twice and co-created an equitable, community-informed roadmap outlining the action steps needed to support passage of Massachusetts stock albuterol legislation.

Project Objective 2

By month 6, we will deliver at least one educational session to the Massachusetts School Nurse Organization highlighting the role of stock albuterol in reducing inequities in access to emergency asthma medications in elementary schools and by month 12, we will provide them with a disseminated summary brief that outlines guidance to equitably improve school nurses’ knowledge, confidence, and capacity to implement stock albuterol programs across diverse school communities.

Project Objective 3

By month 5, we will implement stock albuterol programs in one urban and one rural elementary school to equitably assess the impact of stock albuterol in two community settings and by month 10, we will track all administrations, outcomes, and user experiences from the program to generate a final evaluation report that reflects the needs of students, families, and school nurses in varied community settings.

AAP District

District I

Institutional Name

Boston Children's Hospital

Contact 1

Maria Moncaliano, MD