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

BACKGROUND AND OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.