Education, advocacy may mitigate impacts of climate change on allergy, asthma outcomes

Key takeaways:

• Climate change increases the length of pollen seasons as well as pollen loads and proteins.
• Urban areas face disproportionate effects on respiratory health due to heat and air pollution.

SAN ANTONIO — Climate change is making allergies and asthma worse, but patient education and professional advocacy may mitigate these impacts, Jeffrey Demain, MD, FAAAAI, FACAAI, FAAP, told Healio.

“The most important thing is education,” Demain, a clinical professor in the department of pediatrics at the University of Washington, said during the 16th Annual Allergy, Asthma & Immunology CME Conference.

For example, Demain said that patients with pollen allergies already are aware of when pollen seasons occur.

“Now those periods are longer, starting earlier, and they can expect higher levels of pollen,” said Demain, who also is medical director of Lux Infusion. “It’s very important to educate the patients on how these systems are changing and how they should prepare for that.”

These longer pollen seasons in addition to increases in air pollution also increase the risks for more severe events, Demain continued.

“People with asthma and allergies are going to be more affected than somebody without respiratory disease,” he said. “When you have aggregates of pollen with these pollutants, you have a much more intense immune reaction.”

Particulate matter at the 2.5 µm scale and smaller, which Demain called the No. 1 pollutant impacting respiratory disease, is small enough to penetrate deep into the lungs. Also, nitrogen dioxide and sulfur dioxide can lead to surface-level ozone.

“When you have volatile organic compounds, such as exhaust, you add to that nitrogen dioxide, you add to that sun, and you add to that heat. That’s when you get high levels of ozone,” Demain said.

Previous studies have indicated associations between ozone and respiratory diseases including asthma attacks and hospitalizations, he continued.

“It’s that combination. It’s not really just one thing. It’s how they all interface,” Demain said.

Urban areas experience even greater effects because of multiple factors such as higher levels of carbon dioxide and heat as well, compared with rural areas, he said.

“The heat island effect can have a very significant impact, especially on the more vulnerable populations,” Demain said. “They may not have access to cooling. They may not have access to being indoors, where they can shut windows and doors when the pollens are high or when the molds are high.”

Specifically, Demain noted, the higher carbon dioxide levels in urban areas produce much higher pollen loads compared with rural areas, including increases in the specific proteins that cause allergic reactions.

Demain further cited European studies indicating that residents of urban areas face a 50% greater risk for asthma compared with residents of farming communities and those who work with livestock.

“Back to that urban living, you’ve got a lot of factors that increase the risk of intensifiying allergic and respiratory diseases,” he said.

Patients need to be aware of these multiple risks, Demain said, adding that he and most allergy colleagues place great emphasis on providing education.

“As allergists, we pride ourselves in taking the time to educate,” he said. “This is something we address every time we see a patient. We oftentimes provide literature for our patients. On our websites, we notify them of high pollen loads. We notify them of air quality.”

The practice that Demain founded founded conducts the pollen counts for Anchorage and South Central Alaska. Pollen counting is also accomplished in Fairbanks, addressing the Interior of Alaska.

These data are widely provided on websites, news media and other outlets, Demain said, adding that through the National Allergy Bureau, pollen counts are available in most regions of the United States and can be readily available.

Also, effective education needs to be consistent, Demain said, and providers should feel comfortable repeating these messages every time they see a patient.

“It’s like telling someone to stop smoking once, it’s probably not going to be very effective. But then explaining over time how smoking is impacting their health, and make sure you can provide strategies for them to quit, over time, that may be more effective,” he said.

Similarly, providers can guide patients with asthma and allergies through using certain air filters in their homes and in using protective covers on their mattresses, along with closing their windows during periods of high pollen and poor air quality.

Patients are receptive to this approach too, Demain added.

“Do they go home and enact them all the time? I think they go home and enact some,” he said. “Maybe they feel compelled to do it for a period of time. Maybe that slides off as life gets busy. But then when you see them again, you’re reinforcing it again.”

Maybe that behavior then gradually becomes habitual, rather than something they do but then forget in a few weeks, Demain said.

Providers also can effect change on the policy level, in addition to the patient level, Demain continued. For example, he said that providers should make themselves available to legislators who do not have the full picture of how climate change affects health.

“They’re looking at what this is doing in a hundred years,” he said. “Make sure that they understand that this is affecting our population right now and that it is having direct health effects right now, and those effects are only going to get worse.”

These efforts to increase awareness among policymakers often comes down to money, Demain continued.

“As these health effects become more problematic, so does the cost of health care,” he said. “When you’re looking at more issues in an urban area, there’s going to be a higher percentage of patients that are getting assistance from the federal government for their insurance.”

With many legislators in tune with the costs of medical care, Demain said, the goal is to make sure that they have the full picture of what is happening today and not just in the future.

In fact, Demain described the many impacts that climate change already is having on Alaska, where he lives.

Fish have migrated north in search of colder waters and mammals no longer have sea ice to inhabit, making it more difficult for village residents who live on subsistence to find food to eat, he continued.

“I’ve lived in Alaska for 30 years, and it is first-hand witnessing. This is not looking into the future. It’s looking at it right now. The impacts of climate change are tremendous,” Demain said. “Environmental changes are occurring, they’re real, and they’re very directly connected to climate change.”

Reference:

• Demain J. Climate change and the impacts on atopic disease. Presented at: Allergy, Asthma & Immunology CME Conference; Aug. 1-4; San Antonio.

For more information:

Jeffrey Demain, MD, FAAAAI, FACAAI, FAAP, can be reached at jeff.demain@luxinfusion.com.