ACAAI 2018 Perspectives - Episode 9
Kanu Sharma, MD
California is recovering from a nightmare wildfire season; dozens died, thousands were displaced and hundreds of thousands of acres were burned, taking out entire communities.
For hundreds of miles beyond the burn areas, skies went dark for days and the air was thick with smoke. Even healthy residents were advised to stay inside. For Californians with breathing problems, extreme measures were in order.
Debbie Dobrosky, a 67-year-old Riverside County resident with chronic obstructive pulmonary disease (COPD), told National Public Radio that even inside her apartment she had to use her inhaler twice on one August morning, “which is not a normal thing."
"Today I'm stuck inside,” she said, “there's no going out."
Dobrosky is among about 1.1 million adults in California and some 16 million Americans with COPD, about a third of which are over 65 years old. Another 5.2 million Californians have asthma, which affects about 1 in 12 people across the country.
Coming from a family of physicians, some who are working in California, the same issues have been coming up in our conversations recently. How do we as a medical community better prepare for wildfires? How do we allow patients to continue their lives without major interruptions? And how do we prevent chronic illnesses from flaring up and risking lives?
These questions are especially pressing as millions of our patients are being told that this is the “new normal” in the western United States. Wildfire season is lasting longer around the world, the number of major wildfires in the Great Plains has tripled in just 30 years and structures lost to wildfire in the American west has increased by 300 percent.
During a brief respite before the next series of wildfires begins, everyone from physicians to policymakers, insurance companies, healthcare executives and tech companies should be racing to develop and disseminate medical solutions that will save lives in the years to come.
There are some basic steps that physicians should be advising their patients to take, like staying inside as much as possible and controlling the environment indoors. If your patients are using an air conditioner, advise them to close the fresh-air intake so smoke isn’t coming inside. Help them appreciate the benefits of buying an air cleaner with a HEPA filter to clean the air. Ensure that your patients aren’t smoking inside, burning candles, starting fires or using a gas stove.
If your patients must go outside, let them know to wear a particle respirator mask, which can filter out 95 to nearly 100% of airborne particles. (The Centers for Disease Control and Prevention has a comprehensive rundown here of what people should be looking for in a respirator mask).
But this advice still leaves patients largely on their own when the fires sweep through and they shut themselves indoors. For physicians with hundreds of patients, it means hoping that they are following your advice and not meeting unexpected problems.
So how can we keep an eye on patients? How can patients and physicians track in real time how air conditions are impacting health?
That’s the question we are working to answer at Adherium, where we have developed a technology solution called Hailie, for people with chronic respiratory disease. Our solution includes a sensor that attaches to an inhaler and wirelessly transmits usage data to both patients and physicians, allowing them to track it in app and web-based dashboards.
The device reminds patients when it’s time for a dose, but it can also provide crucial information that allows physicians to intervene before breathing difficulty progresses to something much more serious. In the process of monitoring and tracking therapy usage, physicians also get lots of other information about what sort of challenges the patient is experiencing in terms of their environmental.
This information can be used to make sure patients are following best practices to prevent wildfires from making their breathing problems even worse. Are they wearing their mask properly? Have they closed off air intake on the air conditioner? Do they have enough doses on hand to make it through the next few days?
The idea that wildfires are the new normal is hard to accept for anyone living in high-risk areas. But the anxiety is particularly severe for those worried they won’t be able to breath every time the smoke starts to spread.
We have the tools to help. Let’s make sure we are ready to use them the next time the fires flare up.