Opinion | Are My Patients Safe Amid Rising Temps?

This summer, temperatures broke records all over Europe and are still going up around the world. Right now, California is in the middle of a heat wave that is making it very hot. These extremes have caused heat-related injuries, regional fires, severe weather, and more people getting sick, especially those with long-term lung diseases.

Since 1980, the average ambient temperature has been going up, and it will reach its highest point in 2016 and 2020. This means that things that were once unusual are becoming more common.

To help patients who are affected by extreme heat, poor air quality, and wildfire smoke, healthcare professionals need to be more aware of the problem, come up with new strategies, and speak out. Here, we’ll talk about the basic risks of too much heat, the effects of extreme heat and bad air quality on respiratory health, the problems that wildfire smoke can cause, and the tools that doctors and nurses can use to help people with long-term lung diseases.

The Risks of Excess Heat

The U.S. Global Changes Research Program keeps track of the health effects of severe heat events as described in CDC Morbidity and Mortality Weekly reports. For example, they keep track of deaths caused by severe heat waves in Kansas City and St. Louis (1980), Chicago (1995), and California (2006).

Extensive cohort studies were done in Europe and the U.S. to learn more about these links. They showed that hospital admissions for respiratory symptoms and deaths were linked to heat events. Michelozzi et al. thought that people with chronic respiratory diseases might have trouble controlling their body temperature and might over breathe, which could lead to more dynamic hyperinflation or narrowing of the blood vessels in the lungs.

But this group isn’t the only one that can get sick from direct heat, especially as temperatures continue to rise.

When the body’s normal ways of regulating temperature are overwhelmed, heat-related illnesses can happen. People are more likely to get sick when the temperature outside is higher than their normal body temperature and the humidity makes it hard to get rid of heat through evaporation. The most dangerous kind is heatstroke, which is a combination of hyperthermia (core temperature over 105°F) and mental changes, seizures, and coma.

Hypovolemia, which is caused by fluid loss to the environment, makes heat stroke worse by narrowing the blood vessels in the skin and making it impossible to move heat from the core to the surface so it can escape. Heat exhaustion isn’t as bad as heatstroke, but it needs to be taken care of quickly because it can lead to heatstroke. When someone goes from heat exhaustion to heat stroke, their mental state changes. The treatment should start right away and includes taking off clothing that keeps heat in, putting the person in cold water, giving them ice packs, and replacing intravascular volume and electrolytes.

Importantly, the best way to avoid these heat injuries is to take steps to prevent them and be aware of the risks. A CDC pamphlet on how to keep patients from getting sick from the heat is a useful tool. It recommends sensible steps, like spending less time outside and staying hydrated, and gives tips for people who are at a higher risk, like those with chronic diseases.

The Impact on Air Quality and Particulate Matter

In addition to temperature, we must also think about the quality of the air. The spread of disease is made worse by bad air quality, which gets much worse when it’s very hot. The CDC checks six air pollutants, like ozone and particulate matter (PM), that affect air quality. These pollutants are part of the Air Quality Index (AQI). PM2.5 and PM10, which are measured in micrograms per cubic metre, are what make up fine PM.

Patients who over-ventilate, like those with emphysematous COPD who need higher minute ventilation, are more likely to be exposed to PM. In 2017, the Medicare database of more than 60 million patients was used by the New England Journal of Medicine to find a link between death rates and local ozone and PM2.5 levels across the continental U.S. The results showed a strong direct link between the levels of ozone and PM2.5 and the total number of deaths.

High-pressure systems that stay in one place over a region are usually what cause severe heat waves. Air pollutants like ozone, PM2.5, and nitrogen dioxide (NO2) are made and trapped by a weather pattern called “heat dome,” which makes the air quality worse. When ozone and PM2.5 build up to very high levels, they cause inflammation, bronchoconstriction, and the production of mucus when they are breathed in.

Exposure to ozone and PM2.5, even for a short time, has been shown to lead to more asthma-related trips to the emergency room and hospitalizations. In a panel study of asthmatics, hourly PM2.5 and temperature were looked at to see if they were linked to how well asthmatics’ lungs worked. The study found that increased use of rescue bronchodilators was linked to short-term increases in PM2.5.

Opinion Are My Patients Safe Amid Rising Temps?

The temperature and quality of the air outside are important, but many people with long-term lung diseases spend most of their time inside. McCormack et al. did a study and found that breathing problems, coughing, and making sputum all got worse when it was hot inside. The effect was made worse by high levels of NO2 and PM2.5. And homes that use less energy can trap and gather ozone, NO2, PM, smoke, and pet dander.

The Role of Wildfire Smoke

In the last ten years, there have been a lot more wildfires all over the world. In the U.S., wildfire season is longer, fires are worse, and more land is burned. The same chemical pollutants that were talked about before are made by wildfires, but there are more of them. Several studies have shown that people with no history of asthma are more likely to have bronchospasm, use rescue inhalers, go to the emergency room, and be admitted to the hospital because of asthma in areas where wildfires are happening. But healthcare professionals can help lessen the effects by communicating and taking steps to improve public health.

The American Thoracic Society (ATS) has a great educational pamphlet that tells people with chronic lung diseases how to take care of their health during wildfires. It says that people who live in areas with wildfires should plan to leave early, set up a clean room with recirculating air conditioning or an air purifier, follow a care plan, and have extra medicine. Healthcare professionals should learn about these suggestions so they can share them with patients who are at risk.

The Need for Greater Advocacy

One last point is how important it is for healthcare professionals to advocate for clean air policies that will improve the lives of their patients. The 2012 ATS Workshop Report is a great example of advocacy. It was made after a workshop where experts from important professional societies and government agencies got together to talk about important threats that climate change poses to global respiratory health.

As the U.S. saw after the Clean Air Act of 1970, when the air quality got better, the number of diseases related to it went down. A recent report from the Environmental Committee of the Forum of International Respiratory Societies describes how local, regional, national, and international efforts have affected health outcomes. Healthcare providers can change this dangerous pattern to save lives and reduce the number of people who get sick.

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