My 9-year-old has asthma and we are stru

Do this first, today, before the school nurse leaves at 3: get one working, unexpired reliever into the house. Right now the one gap in your plan is that his inhaler is nearly out, and that is the gap that turns an ordinary asthma day into an ambulance day — and it is fixable today without changing anything about his treatment.

To be clear about my side: I don't diagnose, I don't change his treatment, and I can't tell you how many puffs are left in that canister or write a new step into his plan. What I can do is name the signs that mean call, and lay out what to do at home and what to ask for today.

One thing I need from you, at the end: which country or city are you in? I don't guess emergency numbers or medicine-assistance schemes from language, and what help exists depends on where you live.

1. What you've already tried, and what works better

Stretching the last puffs out. I understand why — but it backfires. A metered inhaler that is nearly empty stops delivering a consistent amount with each press, and a canister at the end of its life can feel full and give very little. Spacing his doses out to save puffs is not a safe plan for a child whose attacks can come on fast. Keep using his own reliever exactly the way he was taught, and treat *replacing it* as the fix. I can't tell you how many puffs are left or change his plan — the written action plan already in your kitchen is the authority on that, and his prescriber or pharmacist is the authority on the device.

Better levers, all reachable today:

• Ask the school nurse, before 3. Two questions: does the school keep an emergency reliever, and who is allowed to use it; and can the school help with any medication-cost paperwork. She sees more of this than anyone else in your week.
• Ask the nurse for his prescriber's name and the school copy of his asthma action plan. The school copy and your kitchen copy are sometimes not the same document.
• Call his clinic today or ask the nurse to help you request an urgent appointment. Say three things out loud: he's 9, he has asthma, and the cost is the barrier, not the concern. That sentence changes what a clinic offers — but which subsidies or assistance schemes exist depends on your country and region, which is why I need that from you.
• At the next visit, ask for technique to be watched. With a spacer, technique is often wrong in children, and it is the one thing that can be fixed in ten minutes. Say it plainly: "please watch him use it."
• Ask what to do when the inhaler runs out, on paper. His action plan should say that. You are not the right person to invent a new step, and I won't write one for you.

2. Constraints and the avoid list

• Don't ration, thin out, or stretch puffs. Don't use a canister you believe is finished.
• Don't borrow anyone's inhaler or oxygen — including from another child, a relative, or a school bag.
• Don't start leftover antibiotics or steroid tablets from a previous flare, and don't add or change an inhaler, a preventer, or a plan step at home. That is a prescriber decision.
• Don't buy inhalers, or any "breathing powder", syrup or herbal product, online or off-market. Anything not dispensed for him by a pharmacy against a prescription is not something I can help you use safely.
• Don't let a home pulse oximeter or a home peak-flow reading decide to stay home. A good number does not rule out a serious attack.
• Keep the spacer with the inhaler, not loose in a drawer. A spacer that is dusty, chewed or mismatched delivers the dose poorly.
• Smoke and cooking fumes: free to fix tonight. No smoking or vaping indoors, windows open when cooking, no wood or open-fire smoke near him. This is one of the strongest things you can change at home.
• Food: nothing in your kitchen prevents or stops an asthma attack. No honey, herbal syrup or kitchen remedy for his breathing. Normal family meals, and if he's uncomfortable let him sit upright.

3. Decision tree — screenshot this

Q1. Can he speak in full sentences right now?
No → call your local emergency number now. Yes → Q2.

Q2. Are the ribs or neck sucking in, is he grunting, or are his lips or fingertips blue?
Any yes → call your local emergency number now. No → Q3.

Q3. Did the wheeze that was there a minute ago go quiet while he still looks unwell? Is he drowsy or hard to wake? Can he not walk to the door?
Any yes → call your local emergency number now. No → Q4.

Q4. Sudden onset after a food, a sting or a medicine, with swelling, throat tightness, or a hoarse voice?
Yes, or you cannot be sure → call your local emergency number now and say the word anaphylaxis on the call. No → Q5.

Q5. Night waking, needing the reliever more than usual, or a cough with a cold that's creeping up?
Yes → same-day clinician, not "tonight and hope." No → still get the appointment this week; the inhaler supply is the issue.

While waiting for anyone: let him sit up, or keep whatever position he's chosen — do not lay him flat. Stay with him. Use only his own prescribed reliever with his own spacer, the way he was trained. Have the action plan, all his inhalers and the spacer in your hand for the dispatcher. Do not wait to see whether he improves.

Scripts you can screenshot

To the school nurse, before 3:
> "Hi — my son, [name], is 9 and has asthma. His rescue inhaler is nearly empty and we can't manage a refill this week. Does the school keep an emergency reliever, and who is allowed to use it? Can the school help with any medication-cost scheme? And could you tell me his prescriber's name and whether the school has a written asthma plan on file?"

To the clinic or the pharmacist:
> "He's 9, he has asthma, and his reliever is running out. The cost is the barrier, not the concern — what help exists for the medicine itself? Could his inhaler technique be checked, and is there a written plan I should be following?"

Three things worth asking at the visit:

• Is his preventer right for him, and does the plan change if the reliever runs out? *(the answer belongs in their plan, written by them)*
• How do I know the inhaler is empty, and should it be replaced on a schedule instead of when it dies?
• Who signs off the school copy of the plan?

What success looks like in 24 hours

No cures promised, and I can't promise the money question solves itself. But this is achievable:

• One working, unexpired reliever and spacer in the house, a second one at school, and a written plan that says what to do when it runs low.
• No rationing, no stretched puffs — use only what the plan says, with a full canister behind it.
• You can name the four signs that mean "call", without looking anything up.
• One cost route written down, even if the money hasn't arrived yet.

Not covered by me, so ask a clinician rather than guess: puff counts, peak-flow or oxygen-saturation numbers to stay home with, homemade spacer or nebuliser recipes, leftover steroid or antibiotic courses, and which subsidy or assistance schemes exist where you live.

What I still need: your country or city, so I can point you to the right local door for the reliever and confirm it rather than guess.