New to school nursing and I am trying to do things "by the books", which has apparently caused some upset with a parent or two. Elementary age student with asthma has proAir prescribed 2-4 puffs q4-6h PRN cough/wheeze. Student presents to clinic prior to pe requesting inhaler. Student says mom sent her since she had cough this morning. Student takes 4 puffs, with no pauses between and runs off to pe. I called parent to advise that I did allow student to use inhaler, however, I needed clarification order from Doctor if student needs inhaler prior to exercise in the absence of symptoms listed for use. I wasn't rude, just letting her know that isn't how it was prescribed and that the doctor could just fax over something clarifying in the event it was just omitted in error. The parent began to chastise me and in no so many words question my ability to do my job and said I was causing "problems" already. Fast forward, student comes in the following day, requesting inhaler prior to pe. No SOB, wheezing or cough noted. Lungs clear. Allowed student 2 puffs from inhaler and provided education to allow 30s to 1 minute before taking another puff. Student then went to PE. The student returned about one hour later (nearing end of pe) and was short of breath. Could have been the exercise or asthma or a combo. No wheezing or coughing. Allowed student remaining 2 puffs of inhaler. Instructed pursed lip breathing and monitored until sob discontinued. I am fairly sure I will be getting a call Monday and it will likely be worse. My thoughts are this 1)I am already technically going against physicians specific prescribed method, however, I also didn't want child going into full blown asthma attack because I refused inhaler. 2) I considered the likeliness of the increase in heart rate through exercise and medication and opted for 2 puffs since no symptoms were present. Can someone please shed some light on this? I am dreading the parent communication when I get the call that the child had issues because I didn't give 4 puffs. I don't know how to deal with the parent who apparently gives the child the inhaler frequently in the absence of symptoms as well as max puffs and improperly (consecutive puffs with no pauses). I hate that it's my first week on the job and there is already a parent I can tell will give me grief all year long and probably go complain to principal about me. I am a parent myself so I understand how we often know our own children better than strangers. On the flip side, I have a license to protect and nursing judgment to guide me in making decision with children that are not my own. Help!!!