Asthma Hypothetical

[fetch, BSN, RN]

I just had a parent bring in a new inhaler to replace the one that expired at the end of November. I sent him home with the old one and told him to check with his daughter's doctor, as most of them will tell you it's ok to use an expired inhaler for a few months after the date if necessary. He asked me, "so if [daughter] had come in here gasping and wheezing and all you had was the expired one, would you give it?"

Interesting question! If it were my own asthma acting up - yes, I would take MY OWN expired inhaler if I was in trouble. If I was the parent and it was in my own home - yes, I would give my child their expired inhaler and watch like a hawk.

As a school nurse? No way!

I explained to him that I'd call him first - if the attack was Yellow Zone dangerous, just some wheezing, there would be plenty of time to get the parent there with medication (or to give the expired one if they chose). If the attack was Red Zone dangerous, I'd call 911 immediately - we have an excellent response time, and they can give her the full nebulizer treatment and monitoring she would need for a truly severe attack.

But what if we didn't have the great response time, or the parents couldn't be reached? Is there any time when you as a school nurse would give a student an expired inhaler?

[Nurse ABC]

If a student were having a bad asthma attack I would just call EMS because if an inhaler is expired you don't know what the effectiveness of it is. If it's mild then maybe if the expiration date was within a month and you couldn't reach the parents. However, it's better to not let yourself get in that position of having to figure it out. We give the parents ample notice to provide a new one and pick up the expired one by a certain date with the knowledge if it's not picked up by the date said the medication will be disposed of.