Q&A: Physicians can help patients with respiratory diseases prepare for wildfires

Key takeaways:

• Wildfire smoke includes particle pollution that can penetrate deep into the lungs.
• Patients with asthma should have a travel bag including medications ready in case they need to evacuate.

As wildfires continue to spread across the Los Angeles area, residents with asthma and other respiratory diseases face increased risks to their health.

Healio spoke with Felix Aguilar, MD, MPH, medical director for quality, L.A. Care Health Plan, and volunteer spokesperson for the American Lung Association, about how clinicians can best help these patients during wildfire crises.

Healio: How do the current fires in the Los Angeles area compare with other wildfires in terms of what they are consuming and the pollution they are creating?

Aguilar: The Los Angeles area fires, among the most destructive in California history, have left a trail of devastation, destroying over 10,000 homes and buildings. The Los Angeles County Health Department declared a public health emergency due to the pollution created by the fires, which pose significant health and safety risks for residents across the county.

Healio: Do you anticipate any differences in risks for respiratory health because of the unique nature of these fires?

Aguilar: Yes. The nature of the Los Angeles fires, characterized by their intensity and the large area they cover, presents significant risks for respiratory health. Wildfire smoke contains particle pollution that can travel deep into the lungs and embed itself there, leading to breathing problems. The minuscule particle matter can also enter the bloodstream and cause inflammation, aggravating diabetes, chronic heart disease and other health conditions.

Healio: Could you provide some specifics about how these fires may impact patients with asthma?
Wildfire smoke contains a mix of pollutants, including elevated ozone and fine particulate matter. Inhaling tiny particles of smoke can cause lung irritation and inflammation, leading to coughing, wheezing and shortness of breath. Breathing wildfire smoke can increase more severe asthma attacks, hospitalization and premature death. Moreover, exposure to smoke may be linked to the onset of asthma, long-term damage to lung function and increased mortality.

Even after the fires are out, people with asthma should stay alert to potential lung damage. They should be aware of the potential to come into contact with asbestos, arsenic, nickel, lead and other hazardous materials from older homes and buildings that were burned. For people with asthma who are going back to homes or buildings to clean up and salvage belongings, the Lung Association advises that the risks are not over. Exposure to ash and toxic chemicals from building fires during cleanup is dangerous. To reduce exposure to ash and other toxins during cleanup, one must wear an N-95 mask (dust masks are ineffective), protective clothing, gloves and goggles. People with asthma can make better decisions about their health and safety by staying informed on the wildfires.

Healio: How can physicians ensure that patients with these risks who must evacuate maintain the care they need?

Aguilar: Physicians must recommend that patients with respiratory disease have a travel pack. In case of an evacuation, patients with chronic lung disease should be encouraged to gather all their medications, delivery devices, prescriptions and insurance cards to have handy to go.

Healio: How can physicians ensure that patients who are sheltering in place best protect themselves?

Aguilar: Physicians must recommend that patients who are sheltering in place stay indoors and avoid breathing smoke, ashes and other pollution. Moreover, they must protect the air in their homes by shutting windows and doors, preferably keeping indoor air circulating through air conditioners in the recirculation setting.

Healio: At the policy level, what can be done to better protect patients with respiratory risks?

Aguilar: We must tackle air pollution and work earnestly to mitigate the global climate crisis. We also must prepare for future climate-related severe environmental events to decrease their effects on our health and lives.

To tackle air pollution, we must work on policy and regulation, public awareness and behavior change, and technological advancements. We must have stricter emission standards to enforce firmer limits on industrial emissions, vehicle exhaust and power plant pollutants. Technological advancements in air quality are necessary. Moreover, energy efficiency will require upgrading vehicles, buildings and appliances to reduce energy consumption.

To mitigate the global climate crisis, we must transition to renewable energy, reduce deforestation, protect ecosystems and promote sustainable practices. We must stimulate reducing, reusing and recycling. We must also promote sustainable agriculture and agroforestry. Finally, we must strengthen international cooperation to implement global agreements and commitments.

To prepare for future climate-related events, we must increase infrastructure and resilience, improve disaster preparedness, strengthen public health systems and conduct research and innovation. We need to construct climate-resilient infrastructure, which includes building flood defenses, seawalls and drought-resistant water systems to withstand extreme weather. Furthermore, smart urban planning must guide cities to ensure green spaces to manage heat waves and properly manage flood-prone areas.

Public health systems must be strengthened, and health monitoring and surveillance for climate-related health issues such as heatstroke, vector-borne diseases and respiratory illnesses must be enhanced. Climate-related research and innovation must be improved to develop new technologies, such as investing in carbon capture, geoengineering and advanced forecasting tools.