Q&A: How patients with lung diseases can beat extreme heat

Key takeaways:

• Extreme heat poses a serious threat to individuals with various lung diseases.
• Staying indoors in cool areas, keeping hydrated and wearing light clothing are recommended.

With temperatures rising and heatwaves occurring across the U.S., this summer season has the potential to seriously harm patients with asthma, COPD and other lung conditions.

Further, increased air pollution and lingering wildfire smoke are only making this summer even more dangerous for individuals who struggle to breathe.

To learn more about the impact of extreme heat on patients with lung conditions, how patients can protect themselves during heatwaves and measures the medical community should take now to prepare for a future of climate change, Healio spoke with Victor Waters, MD, JD, FCLM, chief medical officer at Dignity Health St. Joseph’s Hospital and Medical Center and St. Joseph’s Westgate Medical Center and national spokesperson of the American Lung Association.

Healio: How can extreme heat affect patients with asthma, COPD and other lung conditions?

Waters: Heat has a very significant impact on our patients with chronic pulmonary disease, asthma and any related lung diseases. It impacts them directly and indirectly. The heat itself can be debilitating for patients who have chronic lung disease; in extreme heat, it can be very difficult to inhale that type of heat. Additionally, the ozone layer is increased during heat waves, which in turn worsens pollution. Anything that worsens pollution could put our patients with lung diseases at risk for exacerbations, worsened condition and the need to use more medication.

Healio: What should pulmonologists be telling their patients when it comes to staying safe during heatwaves?

Waters: Laying low and staying away as much as you can from heat are generally recommended. Patients should stay in air-conditioned areas and not rely so much on fans. There is a tendency, particularly among people living in Arizona, to be careful how they use their air conditioning because of the high electricity bill, but that’s a dangerous thing to play with. You should think of your health first and be in a comfortable area using the air conditioner as you need to. This is particularly important for anyone who has chronic lung disease and is aged older than 60 to 65 years. Pulmonologists should also recommend wearing light clothing and hydrating. Particularly in Arizona, the climate is very dry, putting patients who may not necessarily see themselves as vulnerable at risk for being dehydrated.

Healio: Given that heatwaves can be worse in cities, does climate change stand to worsen health inequities?

Waters: I’m on the National Diversity Council and have been very active in health equity issues, so this is a very important topic. In urban areas, people may live in places that are more at risk for pollution and be closer to the highways, and the heat factor only exacerbates all these things. Further, multigenerational living in small environments can also place individuals at higher risk. It can be quite uncomfortable in a very small living environment trying to maintain coolness.

Having access to care when patients, including young children, who have asthma or chronic lung diseases do get sick from major heat-related illnesses is another limiting factor. Emergency rooms are more crowded than ever, particularly in urban environments that I’ve worked in, so having adequate access to care, primary care, their specialists, and/or the ED becomes very limiting, and it places them at risk.

Healio: How can people protect themselves from the combination of air pollution and extreme heat ?

Waters: We have talked about this in the past predominantly in other parts of the country, such as California, where you had this trifecta of COVID-19, heat and air pollution. Now we have a different trifecta that includes heat, pollution and smoke from wildfires. All those things are irritants to the lungs, so there needs to be more awareness of and alerts about pollution levels for people who have chronic lung disease so that they can move swiftly to areas that are safer.

Individuals with lung diseases should monitor air quality levels just as someone who has diabetes monitors their sugar levels. You have no idea how high or low the air quality is, or the risk associated with the air you’re breathing unless you use the proper type of monitor. There are all kinds of apps out there that can alert people. Even though you hear these levels in the news, there needs to be a far greater aggressive push for people to be aware of these levels and avoid them when they are dangerous. You know the temperature, but you may not know the ozone layer or pollution numbers.

Pollen is another measure of which people need to be aware, especially those with allergic asthma. Recently, there have been some of the highest pollen counts in cities, and it has exacerbated asthma and chronic lung disease. Lung disease is very complex because there are so many things that we can inhale which can aggravate and create exacerbation.

Healio: Considering we’re looking at a future where heatwaves are more common, how should the medical community and pulmonologists specifically prepare now?

Waters: In preparing for the future with climate changes, there must be a lot more educational drive and making sure patients don’t underestimate their level of heat tolerance. People underestimate their ability to compensate for the heat that’s happening even in places with very high climates, such as Phoenix. There’s a range of symptoms that you can have when you get in trouble. It can go from just sunburn and feeling hot, to cramps, to potentially nausea and vomiting. People essentially underestimate their risk for entering these ranges, which can easily escalate to experiencing heat stroke, something life threatening that can kill you. There must be much greater education with not just pulmonologists but with primary care doctors. Thankfully, the American Lung Association is working hard to promote early recognition just like the days when doctors promoted recognition of stroke signs. We are always talking about the early signs of stroke and transient ischemic attacks including education on what these conditions mean and look like. Minutes matter in these new and extreme weather changes we’re going through.

Through lung.org, the American Lung Association provides updated information on how patients with lung disease should protect themselves during periods of extreme heat. It is a wonderful resource for educational material.

References:

• Extreme heat and extreme cold. https://www.lung.org/clean-air/emergencies-and-natural-disasters/extreme-temperatures. Updated July 7, 2023. Accessed July 28, 2023.
• Lung Association offers tips to protect lungs during extraordinary heat season. https://www.lung.org/media/press-releases/mississippi-heat-wave-alert. Published July 26, 2023. Accessed July 28, 2023.