Stock Inhalers in Chicago Public Schools: Using the RE-AIM Framework to Assess Impact

Chicago children experience disproportionately higher asthma prevalence and worse health outcomes. Stock inhalers can be used to treat asthma exacerbations at school when a personal inhaler is not available. The purpose of this study was to evaluate the guided implementation of a stock inhaler program in Chicago Public Schools.

This mixed-methods pilot study used the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework for evaluation. Four pilot schools were selected based on high asthma prevalence and full-time nurse coverage. Data collection included demographics, pre-/postimplementation semistructured interviews, surveys, and stock inhalerutilization record review. Pilot activities ran from September 2023 through June 2024.

Reach: The program initially reached a student population of 6023 students from 4 schools. Effectiveness: There were 124 total stock inhaler events over the 2023-2024 school year, where 67.5% of students returned to class, 25.0% left school, and 7.5% required emergency services. Nurses believed that stock inhalers improved the student's outcome in 77.4% of incidents with available data. Adoption: All pilot schools used the stock inhaler. Implementation: Protocol fidelity analysis demonstrated that 60.2% of nurses gave the appropriate number of puffs for the incident severity documented. Maintenance: Because of early pilot success and presence of statewide funding, the intervention was upscaled to include 160 181 students from 306 schools by June 2024.

Stock inhaler programming was feasible and beneficial to Chicago Public Schools, improving student outcomes. Guided implementation of scalable school health interventions is essential for future school-based asthma management.