Climate change exacerbates the health effects of wildfire smoke in care deserts

Dresslerville, Nev. — Smoke billows into Northwest Nevada skies in September, blanketing mountains with clouds, dimming the sun — and dashing residents’ hope that they’ll escape wildfires and sweltering air quality.

Lung-burning particles drifted from burning California forests and settled in Douglas County, Nevada, home to about 50,000 people, prompting warnings that air quality was reaching dangerous levels.

These levels mean the air is extremely unhealthy, bad enough to call into question whether people need immediate health care and whether increased pollution could result in long-term health problems. Humans may increasingly face such risks as climate change makes wildfires, droughts, dust storms, and floods more frequent in the United States and around the world.

Some people just feel powerless.

“There’s not much we can do about it,” said Cheryl Smokey, chairman of the Washoe Tribe of Nevada and California. The tribe’s lands straddle the border between California and Nevada near Lake Tahoe and extend into Douglas County, about 60 miles south of Reno.

Tribal members and other area residents are among millions of people nationwide who will experience poor air quality due to wildfires this year. In September, as smoke settled in Nevada, fire-related air quality warnings were sent to six other states: California, Idaho, Montana, Oregon, Washington and Wyoming.

Still, by one measure, people living in Douglas County are better off than some other hard-hit areas. Douglas County residents have to drive an average of 30 minutes to see lung specialists, called pulmonologists. In other parts of the West and upper Midwest, however, patients must drive an hour or more, according to data analyzed by GoodRx, a website that tracks prescription drug prices and conducts research.

Specifically, the study found that nearly 5.5 million Americans live in 488 counties with an hour or more of driving time to a pulmonologist. Much of Nevada and Montana fall into that gap, experts say — places that have recently experienced wildfires that fill the air with smoke and ash, which can cause lung problems or exacerbate existing problems.

Allergies, asthma and similar problems are often managed by primary care physicians, but patients are referred to pulmonologists when problems worsen — think severe asthma; chronic obstructive pulmonary disease or COPD; or emphysema.

Data from the Association of American Medical Colleges shows that the number of pulmonary disease specialists in the United States decreased by about 11% from 2014 to 2019. The group, which is based in Washington, D.C. and represents the academic medicine community, noted that the decline may not be as great as it appears because some physicians are choosing to practice pulmonary critical care rather than just pulmonology. Many of these pulmonologists work in hospital intensive care units.

GoodRx reports that there are approximately 15,000 pulmonologists practicing in the United States. Yet vast parts of the country have little or none.

“There is one pulmonologist for the entire southeastern part of the state of New Mexico, not counting Las Cruces, which is closer to El Paso,” said Dr. Victor Test, a pulmonologist at Texas Tech Physicians.

Test, one of 13 pulmonologists in the Texas region, said his patients from within Texas sometimes drive four hours for appointments, and others travel from “New Mexico, Oklahoma, even as far west as Kansas.”

The increase in wildfires and their severity will likely expand the need for pulmonologists.

“Climate change is going to affect lung disease,” said Dr. Nicholas Kenyon, professor of pulmonary, critical care and sleep medicine at the University of California-Davis School of Medicine, where he and other researchers are tracking. Effects of wildfires. In his Sacramento practice, Kenyon said, he sees patients from far northern California, including Eureka, a five-hour drive from the state capital.

The short-term effects of inhaling smoke are well known. People show up in emergency rooms with asthma attacks, COPD, bronchitis and even pneumonia, Kenyon said. Some have chest pain or other cardiac concerns.

“But we have very little understanding of what will happen in the long term,” he said. “If people are exposed to two or three weeks of wildfire for two or three years, does that make asthma or COPD worse? We just don’t know.”

Fires release multiple pollutants, including chemicals such as carbon dioxide, carbon monoxide, and benzene. All fires send particles into the air. Health researchers and air quality experts are most concerned about the tiny particles referred to as particulate matter 2.5. Much smaller than a human hair, the particles can lodge deep in the lungs and have been linked to heart and lung conditions.

According to a 2020 New England Journal of Medicine overview, an increase in these tiny particles is associated with an increased risk of death from all causes, excluding accidents, homicides and other non-accidental causes, up to four days after exposure in the population. .

Fine particulate matter concentration is one of five gauges used to calculate the Air Quality Index, a numerical and color-coded indicator used to inform the public of local air pollution levels. Green indicates good air quality and is given if the total index is 50 or less. When the measure exceeds 100, the air quality gets an orange label and may be worse for certain groups. Levels above 200 receive a red label and are considered unhealthy for everyone.

Government agencies track those levels, as people use apps or websites to determine whether it’s safe to go out

When the AQI rises above 150, said Dr. Farah Madhni-Lovely, a pulmonologist at Renowned Regional Medical Center in Reno, it closes its outpatient pulmonary rehabilitation clinic because it doesn’t want to encourage patients to drive. Some patients in Douglas County choose care closer to home, about an hour away. “We don’t want these patients to be exposed to the outdoors because just one minute of exposure to smoke can exacerbate their chronic disease,” Madhni-Lovely said.

Contacting pulmonologists can be difficult for Washoe Tribe members, especially those who live on the California side of the reservation, Smokey said. “We can’t find suppliers for them,” he said. “We end up referring them and sending them hundreds of miles out of the way just to take care of what we should be able to provide here.”

Recruiting specialists in rural areas or small towns has long been difficult. For one thing, a specialist can be miles away, “so there’s a tremendous burden in terms of coverage and days off,” Test said.

Another concern is that physicians tend to train in large cities and often want to practice in similar locations. Even recruiting a pulmonary physician in the West Texas city of Lube, population 260,000, is a challenge, Test said.

“I love Lubbock,” he said. “But I tell people who’ve never been here, I say, ‘It’s really flat.’ They don’t understand flats until they come here.”

In Nevada, on days when air quality is poor, Washoe tribal members try to protect themselves with makeshift air purifiers made from fans, duct tape and air filters, Smokey said.

In the long term, Smokey and other tribal leaders are pushing the Indian Health Service to establish a specialty care hospital in northern Nevada. The closest specialty care hospital for Washoe tribal members is more than 700 miles away in Phoenix.

It’s hard because “there’s a need we need to take care of,” Smokey said. “But we have to fight for it. And sometimes that fight takes years and years and years to complete.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Along with policy analysis and polling, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides health information to the nation.

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