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The 411 on Wheezing, Sneezing and Seizing in
Schools

• Theodora Phea Pinnock, M.D.
• Director, Maternal and Child Health
• presented to
• Ken-Ten Coordinated School Health Institute
• September 18, 2007

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The Score Board

• Pre-Game
• Pre-Game Stats
• Game-Time
• Current Efforts
• Trophy Presentation

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• Pre-Game

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Pre-Game Stats

• Asthma in US
• 12.2 (8.9 million) children have been told by
  health professional at some point that they had
  asthma
• Boys were more likely than girls to have ever
  been diagnosed with asthma (15 vs 9)
• Children in fair or poor health were more than 7
  times as likely to have an asthma attack in the
  past 12 months as children in excellent or very
  good health (29 vs 4)

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Pre-Game Stats

• Asthma in US
• Asthma is one of the leading cause of school
  absenteeism. 14.7 million school days were missed
  (2002)
• 5.8 (4.2 million) of children had an asthma
  attack in the last 12 months
• 728,000 children visited hospital emergency
  departments
• 214,000 children were hospitalized due to asthma.
  It is the 3rd ranking cause of hospitalization
  for children under 15

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Pre-Game Stats

• In Tennessee
• 70,900 children with asthma
• 110 deaths from asthma
• 6,100 child asthmatics in Davidson Co

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Pre-Game Stats

• African American children
• are 3-4 times more likely to be hospitalized for
  asthma
• 4-6 times more likely to die from asthma related
  complications
• High rates of poverty, substandard housing,
  environmental racism, inadequate access to
  quality health care are all factors

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Pre-Game Stats

• 50 million Americans suffer from all types of
  allergies (1 in 5 Americans) including
  indoor/outdoor, food drug, latex, insect, skin
  and eye allergies. Allergy prevalence overall has
  been increasing since the early 1980s across all
  age, sex and racial groups.
• Allergy is the 5th leading chronic disease in the
  U.S. among all ages, and the 3rd most common
  chronic disease among children under 18 years
  old.
• Types
• INDOOR and OUTDOOR ALLERGIES (Allergic
  rhinitis seasonal/perennial allergies hay
  fever nasal allergies) Approximately 75 of all
  allergy sufferers have indoor/outdoor allergies
  as their primary allergy. (Many people with
  allergies usually have more than one type of
  allergy.) Approximately 10 million people are
  allergic to cat dander, the most common pet
  allergy. The most common indoor/outdoor allergy
  triggers are  tree, grass and weed pollen mold
  spores dust mite and cockroach allergen and,
  cat, dog and rodent dander.

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Pre-Game Stats

• SKIN ALLERGIES (Atopic dermatitis eczema
  hives urticaria contact allergies)
  Approximately 7 of allergy sufferers have skin
  allergies as their primary allergy. Plants such
  as poison ivy, oak and sumac are the most common
  skin allergy triggers. However, skin contact with
  cockroach and dust mite allergen, certain foods
  or latex may also trigger symptoms of skin
  allergy.
• FOOD DRUG ALLERGIES Approximately 6 of
  allergy sufferers have food/drug allergies as
  their primary allergy. Food allergy is more
  common among children than adults. 90 of all
  food allergy reactions are cause by 8 foods 
  milk, soy, eggs, wheat, peanuts, tree nuts, fish
  and shellfish. For drug allergies, penicillin is
  the most common allergy trigger.

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Pre-Game Stats

• MORBIDITY
• Allergies are the most frequently reported
  chronic condition in children, limiting
  activities for more than 40 of them.
• Each year, allergies account for more than 17
  million outpatient office visits, primarily in
  the spring and fall seasonal allergies account
  for more than half of all allergy visits.
• Skin allergies alone account for more than 7
  million outpatient visits each year.
• Food allergies account for 30,000 visits to the
  emergency room each year.
• Exposure to latex allergen alone is responsible
  for over 200 cases of anaphylaxis (severe
  allergic reactions) each year.
• MORTALITY
• Nearly 400 Americans die each year due to drug
  allergies from penicillin.
• More than 200 deaths occur each year due to food
  allergies.
• Each year nearly 100 Americans die due to insect
  allergies.
• 10 deaths each year are due to severe reactions
  to latex allergy.

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Pre-Game Stats

• SOCIAL and ECONOMIC COSTS
• The annual cost of allergies is estimated to be
  nearly 7 billion.
• Direct costs accounted for nearly 6 billion
  (5.7 billion in medications and 300 million in
  office visits).
• For adults, allergies (hay fever) is the 5th
  leading chronic disease and a major cause of work
  absenteeism and presenteeism, resulting in
  nearly 4 million missed or lost workdays each
  year, resulting in a total cost of more than 700
  million in total lost productivity.

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Pre-Game Stats

• Epilepsy is a condition that affects more than 3
  million people in the U.S.What is epilepsy?
  Epilepsy is a generic term used to define a
  family of seizure disorders. A person with
  recurring seizures is said to have
  epilepsy.What are seizures? A seizure is a
  brief disturbance of electrical activity in the
  brain. There are many different types of
  seizures. People may experience just one type or
  more than one.
• See Handout

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• Game -Time

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Game-Time

• DISORDERS THAT CAN MIMIC SEIZURES
• Mood Disturbance
• Anxiety
• Depression.
• Depression

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Game-Time

• FIRST AID FOR EPILEPSY IS BASICALLY VERY SIMPLE.
  IT KEEPS THE PERSON SAFE UNTIL THE SEIZURE STOPS
  NATURALLY BY ITSELF. IT IS IMPORTANT TO KNOW HOW
  TO RESPOND TO ALL SEIZURES, INCLUDING THE MOST
  NOTICEABLE KIND -- THE GENERALIZED TONIC CLONIC
  SEIZURE, OR CONVULSIONS.

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• KEY THINGS TO REMEMBER
• Keep calm and reassure other people who may be
  nearby.
• Don't hold the person down or try to stop his
  movements.
• Time the seizure with your watch.
• Clear the area around the person of anything hard
  or sharp.
• Loosen ties or anything around the neck that may
  make breathing difficult.
• Put something flat and soft, like a folded
  jacket, under the head.
• Turn him or her gently onto one side. This will
  help keep the airway clear.
• Do not try to force the mouth open with any hard
  implement or with fingers. A person having a
  seizure CANNOT swallow his tongue. Efforts to
  hold the tongue down can injure teeth or jaw.
• Don't attempt artificial respiration except in
  the unlikely event that a person does not start
  breathing again after the seizure has stopped.
• Stay with the person until the seizure ends
  naturally.
• Be friendly and reassuring as consciousness
  returns.
• Offer to call a taxi, friend or relative to help
  the person get home if he seems confused or
  unable to get home by himself.

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Game-Time

• KEY THINGS TO REMEMBER
• FOOD ALLERGY Most prevalent in very young
  children and frequently outgrown, food allergies
  are characterized by a broad range of allergic
  reactions. Symptoms may include itching or
  swelling of lips or tongue tightness of the
  throat with hoarseness nausea and vomiting
  diarrhea occasionally chest tightness and
  wheezing itching of the eyes decreased blood
  pressure or loss of consciousness and
  anaphylaxis.
• DRUG ALLERGY Is characterized by a variety of
  allergic responses affecting any tissue or organ.
  Drug allergies can cause anaphylaxis even those
  patients who do not have life-threatening
  symptoms initially may progress to a
  life-threatening reaction. 

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Game-Time

• KEY THINGS TO REMEMBER
• ANAPHYLAXIS (extreme response to a food or drug
  allergy) Characterized by life-threatening
  symptoms. This is a medical emergency and the
  most severe form of allergic reaction. Symptoms
  include a sense of impending doom generalized
  warmth or flush tingling of palms, soles of feet
  or lips light-headedness bloating and chest
  tightness. These can progress into seizures,
  cardiac arrhythmia, shock and respiratory
  distress. Possible causes can be medications,
  vaccines, food, latex, and insect stings and
  bites. 
• INSECT BITE/STING ALLERGY Characterized by a
  variety of allergic reactions stings cannot
  always be avoided and can happen to anyone.
  Symptoms include pain, itching and swelling at
  the sting site or over a larger area and can
  cause anaphylaxis. Insects that sting include
  bees, hornets, wasps, yellow jackets, and fire
  and harvest ants. 

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Game-Time

• Call 911 if Seizures occur in the following
  situations
• Diabetes
• Brain infections
• Heat exhaustion
• Pregnancy
• Poisoning
• Hypoglycemia
• High fever
• Head injury
• Seizure lasts more than 5 minutes

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Game-Time

• Identifying Children With Asthma
• Wheezing
• Cough
• Shortness of breath
• Rapid breathing
• Chest tightness
• Fatigue
• Irritability

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Game-Time

• Feels funny
• Excessive fatigue
• Poor school performance

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Game-Time

• Common Triggers in School
• Animal Dander
• Cockroaches
• Mold
• Secondhand Smoke
• Dust Mites
• Chemical and strong odors

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Game-Time

• All children with asthma regardless of severity
  can have a severe life-threatening exacerbation
• Always ask about daytime symptoms, nocturnal
  awakening, symptoms early in the morning
• Persist 15 minutes after use of short acting B2
  agonist

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Game-Time

• Risk Factors for Death
• Past history of sudden exacerbation of asthma
• Prior intubations for asthma
• gt 3 ER visits for asthma in last 12 months
• gt1 hospitalization for asthma in last month

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Game Time

• Coordinated School Health Program with DOE-
  coordinated council, survey
• BMI Project with schools
• Increased EPSDT visits especially for adolescents

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Game Time

• Resources for Tennessee Schools
• EPAs IAQ for Schools Managing Asthma in the
  School Environment
• American Lung Associations Open Airways for
  Schools- curriculum, training video-www.lungusa.
  org
• American Association of School Administrators
  Questions School Leaders Frequently Ask About
  Asthma (handout)

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Game Time

• Resources for Tennessee Schools (continued)
• American Academy of Pediatrics Improving
  Childhood Asthma Outcomes in the United States A
  Blueprint for Policy Action

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References

• www.cdc.gov
• www.cdc.gov/ybrss
• www.cdc.gov/health/obesity.htm
• www.cdc.gov/nchs/about/major/nhanes/
  growthcharts/background.htm
• www.health.gov/healthypeople
• www.mchlibrary.info/KnowledgePaths/
  kp_obesity.html

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References

• www.epilepsyfoundation.org
• www.nhlbi.nih.gov
• www.state.tn.us/health
• fcs.tennessee.edu/colorme.htm
• www.aap.org
• www.allergycapitals.org

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• Trophy
• Presentation

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Championship Encouragement

• OUTSCORE Obesity
• SLAMDUNK the Sneeze!
• OUTGUN Obesity!
• WHIP the Wheeze!
• MASTER the Mold!
• DRIBBLE out the Dust!
• STOP the Smoking!
• PRESS away the Pests!

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REACH the SUMMITT!
Its Time!!!!!