Procedural Guidelines

Stock Albuterol Inhaler 

Medical Response for Respiratory Distress for Mild-Moderate-Severe Symptoms

Guidelines and Procedures Sample

The administration of stock albuterol inhalers may be used in the case of: 

• A student with an asthma diagnosis and health action plan but their prescribed medication is not available

• Use the student’s medical care plan and administer the stock albuterol inhaler prescribed dose with a spacer if needed

• A student with no asthma diagnosis and health action plan having difficulty breathing

• Use the school standing order and administer the stock albuterol inhaler with a spacer if needed

Symptoms of Respiratory Distress

School staff that have been trained to administer stock albuterol inhalers should begin the standing order administration based on symptoms of respiratory distress the student is experiencing.

Mild - Moderate symptoms of respiratory distress may include one or more of the following:

• Struggling to breathe

• Whistling in the chest

• Persistent coughing, chest pain, wheezing, chest tightness

• Noisy breathing

• Shallow breathing

• Decreased breath sounds

• Breathing hard or fast and/or shortness of breath

Medical Response to Mild - Moderate Respiratory Distress Symptoms

• Never leave a student alone

• Have the student sit in a chair, or on the ground, and restrict physical activity

• Summon for help, notify parent and school administration, and follow your school division protocol

• If available, a Registered Nurse/Licensed Practical Nurse should obtain and continue to monitor vital signs (pulse, respiratory rate, blood pressure, pulse oximetry) every five minutes or as needed

• Administer albuterol per standing order from the local health provider

- Administer four puffs of albuterol with a valved holding chamber between 15 -30 seconds between puffs

- If symptoms improve and the student has no tightness in the chest, shortness of breath, and can walk and talk easily, continue to monitor

• Keep the student in the health office until breathing returns to normal and the parent or guardian has been contacted

• Refer the student to a healthcare provider for follow-up care

• If there is no improvement in symptoms in ten to fifteen minutes

- Repeat four puffs of albuterol with a valved holding chamber, 15 - 30 seconds between puffs

- Call 911 and follow the actions for Moderate to Severe Respiratory Distress

Moderate - Severe symptoms of respiratory distress may include one or more of the following:

•  Struggling to breathe and or shortness of breath and or hunched over (tripod breathing)

•  Coughing, wheezing, tightness in the chest

•  Difficulty speaking (one word or short sentences)

•  Blueness around the lips or fingernails (may look gray or “dusky”)

•  Chest retractions (chest/neck are pulling in)

•  Use of accessory muscles (stomach muscles are moving up and down)

•  Fast pulse (tachycardia)

•  Agitation

•  Nasal flaring

Medical Response to Moderate - Severe Respiratory Distress Symptoms

If the student progresses to severe respiratory distress symptoms, administer stock albuterol inhaler and follow the standing medical order guidelines for moderate to severe respiratory distress below: 

• Call 911 immediately

• Never leave the student alone

• Have the student sit in a chair, or on the ground

• Restrict physical activity and encourage slow breathing

• Summon for help and notify parent and school administration

• If available, a registered nurse/licensed practical nurse should obtain and continue to monitor vital signs (pulse, respiratory rate, blood pressure, pulse oximetry) every five minutes or as needed

• Administer albuterol per standing medical order 

• Administer eight puffs of albuterol with a valve holding chamber if needed each 15-30 seconds between puffs

• If no improvement of symptoms: repeat eight more puffs of albuterol with a valve holding chamber if needed each 15-30 seconds between puffs

• May give albuterol continuously until emergency medical services (EMS) arrives

• If the student becomes unresponsive, check for a pulse and initiate CPR with rescue breathing

• Continue monitoring the student. A registered nurse/licensed practical nurse should obtain and document vital signs (pulse, respiratory rate, blood pressure, pulse oximetry) and repeat every five minutes or as needed

• Continue monitoring the student until EMS arrives

Schools may have policies and procedures currently in place to administer oxygen to students, and this may continue with a standing order.

(Source:  Virginia Department of Education, 2023).

Below is a PDF copy of the Guidelines and Procedures Sample