Officials at a Texas middle school recently suspended two girls because one loaned the other her asthma inhaler when her classmate, who did not have her inhaler with her, began having breathing problems. Officials cited policies that prohibit the sharing of a controlled substance, which includes prescription drugs like the medicine in inhalers.

According to the American Academy of Pediatrics, schools should immediately confiscate medications students share with classmates and take away the privilege of self-administering medicine.

But what about cases when sharing could potentially save a life?

Setting legal issues aside, we asked two doctors about the pros and cons, from a medical perspective, of sharing inhalers.

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Sharing may not be caring — but there are no absolutes

In general, asthma inhalers should not be shared, says Bradley E. Chipps, MD, a pediatric lung specialist and allergist in Sacramento, California. Chipps is vice president of the American College of Asthma, Allergy and Immunology. However, he says, ''good sense sometimes trumps a rule. Sometimes you do what you have to do."

Antonio Rodriguez, MD, director of the division of pulmonology at Nicklaus Children's Hospital in Miami, says, "The short answer is, 'It's not a good idea.’'' However, he adds, "In a life-threatening event, there might be an exception."

All inhalers not created equal

One reason sharing is typically a bad idea is that one person's rescue inhaler may contain a different medication formula than another person's, the doctors say. If a patient who’s been prescribed one type of rescue medication is given another type by a friend, it might not work as well, says Rodriguez. It may also give them a false sense of security: They may decide they don't need to seek medical help, a big mistake, he says.

Also, not all types inhalers work in an emergency. There are two main types: maintenance inhalers, used on a specified daily basis, and as-needed or “rescue” inhalers. Rescue inhalers contain short-acting medicines that relax and open the breathing tubes in the lungs. Maintenance inhalers have medicine that works more slowly but last much longer. They won't help in an emergency situation, Rodriguez says.

Finally, though the other person may seem like they’re having an asthma attack, the cause of his or her breathing problem could be something else entirely, especially if that person has never been diagnosed with asthma or prescribed an inhaler.

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Inhalers and infection risk

Infection is another concern when an inhaler is passed from one person to another, Rodriguez says. Even in a controlled medical situation, such as a respiratory therapy clinic, experts debate the safety of sharing inhalers, even after the inhaler mouthpiece is wiped with an alcohol pad.

In one study that evaluated mouthpieces after they were disinfected with an alcohol pad, organism growth was evident on at least 5 percent of samples cultured from the mouthpieces.

How else to help

If children are at school when someone needs an inhaler and doesn't have it, it's best to notify the school nurse, the closest teacher or another official, Chipps and Rodriguez say. School administrators should have on file what medication the student in need typically takes and can decide quickly if loaning the inhaler could help..

If the emergency happens out of school and both students know they are on the same medication, that might be an exception to the no-sharing rule, Rodriguez says.

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Whatever the decision about inhaler sharing, trying to convince the person having the attack to stay as calm as possible can also help, doctors say.

Everyone with asthma should have a plan

Children and adults with asthma need an asthma action plan according to the Centers for Disease Control and Prevention (CDC). To develop one, patients or patients and their parents should discuss specific medication needs with their doctor, as well as a plan to avoid triggers and handle emergencies.

About 40 percent of children in the United States diagnosed with asthma have uncontrolled asthma, according to the CDC.

If you’re having an asthma attack, the American Academy of Family Physicians advises you should call 911 or go to the emergency room if:

  • Your inhaler is not helping
  • Your breathing is getting worse
  • Your peak flow gets worse after a treatment, or is less than 50 percent of your personal best (or less than 70 percent if you have frequent asthma attacks)
  • You feel drowsy

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Kathleen Doheny is a Los Angeles journalist specializing in health, behavior and fitness topics.