Climate Change a 'Major Threat' for Respiratory Patients, Experts Warn

The climate crisis represents a "major threat" for patients with respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD), warned a position statement from the European Respiratory Society (ERS) that advocates for stricter air quality standards.

Along with more frequent extreme weather events, the effects of the irreversibly changing climate include rising temperatures, more ozone exposure, prolonged allergy seasons, and the introduction of new allergens, according to Zorana Jovanovic Andersen, MSc, PhD, of the University of Copenhagen in Denmark, and coauthors, writing in the European Respiratory Journal.

"Climate change affects everyone's health, but arguably, respiratory patients are among the most vulnerable," said Andersen in an ERS press release. "Their symptoms will become worse, and for some this will be fatal."

Air pollution remains a key factor in both climate change and respiratory health, as a 2019 estimate indicated that particulate matter with aerodynamic diameter <2.5 µm (PM_2.5) was the cause of 6.7 million deaths globally.

The ERS statement said that health should be central to air pollution reduction policies and to climate change mitigation strategies. The authors called for governments to enact zero emission policies and pointed to the World Health Organization's (WHO) 2021 Air Quality Guidelines, which set new recommendations for yearly average concentrations of PM_2.5 and NO₂ that are five and four times lower than current European Union limits, respectively.

Aligning air quality standards with the WHO guidelines "would avoid substantial health harms related to slowing down global warming, but more importantly, it will translate into immediate gains for health in terms of reductions in health impacts due to poor air quality," wrote Andersen and colleagues.

Their ERS consensus statement also highlighted the role that healthcare providers have in treatment and preparation for the effects of climate change, which are already being felt by many and which will likely become more frequent and severe over time.

"As respiratory doctors and nurses, we need to be aware of these new risks and do all we can to help alleviate patients' suffering," said Andersen. "We also need to explain the risks to our patients so they can protect themselves from adverse effects of climate change."

Wildfires, as well as water damage and subsequent mold risks from floods and heavier rainfall, are among the environmental hazards shaped by climate change that should be considered by physicians, Russell Buhr, MD, PhD, of UCLA Health in Los Angeles, told MedPage Today.

"Just being aware of what types of environmental exposures are changing in your area related to climate change is really important for understanding how to care for each individual patient," Buhr said. "We're uniquely positioned, as people that see the downstream effects on individual health, to also prioritize our ability to advocate for our patients. And that could be through conducting research in these areas [or] sharing opinions and concerns with the greater public."

The sixth assessment report of the Intergovernmental Panel on Climate Change reported that, as of 2020, the world was 1.1°C warmer than it was in the pre-industrial period. This rise has led to changes in weather patterns, an increased frequency of extreme weather events, higher sea levels, and worsened air quality. Researchers noted that these conditions, particularly droughts and high temperatures, can lead to dust storms and wildfires -- the latter of which have recently impacted many throughout the U.S.

Seasons of extreme heat can be difficult for those with respiratory conditions, with an English study reporting a 1.5% increase in the risk of hospitalization for patients with COPD for every 1°C temperature rise. That same study also saw more than 1,800 COPD hospitalization events linked to temperatures above 23°C each year. In the U.S, a 2016 study reported a similar association, with COPD hospitalization risk rising by 7.6% for every 1°C increase above 29°C.

Patients with allergies are also at risk by the changing climate, with shifts not only in the time, duration, and physical areas impacted by different pollen seasons, but also the introduction of new allergens. Thunderstorms, which have been previously associated with allergic asthma outbreaks, may also become frequent.

These changing weather patterns have also been cited as having a possible association with changes in the incidence of pulmonary tuberculosis.

Other vulnerable populations to climate change include babies and younger children, whose lungs are still developing and who tend to breathe at faster rates, potentially inhaling anywhere from two to three times more polluted, allergen-filled, and hot air than adults. Exposure to more extreme heat during pregnancy also may lead to greater risks for low birth weight, preterm birth, and stillbirth.

Buhr emphasized that it will take not only the actions of individuals, but widespread institutional and industrial change to combat rising carbon emissions and subsequently, climate change.

"We're kind of all in this one together," he said. "No individual person is going to be able to stop climate change or its consequences. But if we're all working on the same team to try to make better choices for ourselves and our own health and for the environment around us, [then] hopefully those things together will stave off major, major issues for at least the time being."

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